Claim total
$5,995.71
base $93.83 · payer covered $5,960.71
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1984-04-12
- Stop
- 1984-04-12
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Ramiro Boehm
- Payer
- payer Dual Eligible
Record id
04371635-b149-02a5-6676-356630252ff7