Claim total
$767.69
base $93.83 · payer covered $767.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-11-28
- Stop
- 2024-11-28
The parties
- Patient
- patient Lamar Mark Connelly
- Provider
- provider Lowell Blick
- Payer
- payer Dual Eligible
Record id
050746ba-be7e-c592-565f-c0b5dc1d6840