Claim total
$1,134.94
base $93.83 · payer covered $984.94
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1960-09-22
- Stop
- 1960-09-22
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Criselda Bartell
- Payer
- payer Medicaid
Record id
04371635-b149-02a5-6a62-68526c9f4729