Claim total
$704.41
base $93.83 · payer covered $704.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-12-02
- Stop
- 2013-12-02
The parties
- Patient
- patient Kam Ching Pollich
- Provider
- provider Elbert Schaefer
- Payer
- payer Medicaid
Record id
0681ce4b-c984-7822-3ba1-8453ce082c1e