Claim total
$968.31
base $93.83 · payer covered $818.31
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1950-09-07
- Stop
- 1950-09-07
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Florentino Boehm
- Payer
- payer Medicaid
Record id
04371635-b149-02a5-1e01-0a89db69bd5e