Claim total
$775.00
base $93.83 · payer covered $675.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-08-17
- Stop
- 2006-08-17
The parties
- Patient
- patient Lamar Mark Connelly
- Provider
- provider Lowell Blick
- Payer
- payer Medicaid
Record id
050746ba-be7e-c592-1e22-b98b0a1813b3