Claim total
$780.15
base $93.83 · payer covered $630.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1962-11-14
- Stop
- 1962-11-14
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Lowell Blick
- Payer
- payer Medicaid
Record id
0465c17f-66cb-2155-8fae-04a45a264627