Claim total
$694.97
base $93.83 · payer covered $694.97
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-01-20
- Stop
- 2016-01-20
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Anneliese Bradtke
- Payer
- payer Dual Eligible
Record id
0465c17f-66cb-2155-2210-182aa12d0ec2