Claim total
$5,697.88
base $93.83 · payer covered $5,662.88
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1977-03-03
- Stop
- 1977-03-03
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Criselda Bartell
- Payer
- payer Dual Eligible
Record id
04371635-b149-02a5-c4e0-8e5806acd826