Claim total
$767.69
base $93.83 · payer covered $617.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1966-09-29
- Stop
- 1966-09-29
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Rosio Gleason
- Payer
- payer Medicaid
Record id
04371635-b149-02a5-b488-2a74d7bfec2c