Claim total
$1,047.00
base $93.83 · payer covered $947.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-01-23
- Stop
- 2015-01-23
The parties
- Patient
- patient Danial Hal Lang
- Provider
- provider Leo Bartoletti
- Payer
- payer Medicaid
Record id
06067a48-9015-34d7-13d3-51fbe0d62aa9