Claim total
$767.69
base $93.83 · payer covered $667.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-01-24
- Stop
- 2025-01-24
The parties
- Patient
- patient Danial Hal Lang
- Provider
- provider Leo Bartoletti
- Payer
- payer Medicaid
Record id
06067a48-9015-34d7-0be6-b4fbd027f652