Claim total
$711.72
base $93.83 · payer covered $611.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-09-11
- Stop
- 2014-09-11
The parties
- Patient
- patient Santa Antonina Bernier
- Provider
- provider David Klein
- Payer
- payer Medicaid
Record id
051f1153-ae45-1425-a92e-1f0687700607