Claim total
$973.34
base $93.83 · payer covered $973.34
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-04-01
- Stop
- 2016-04-01
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Anneliese Bradtke
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-ccfa-7951f1923b4b