Claim total
$780.15
base $93.83 · payer covered $680.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-08-11
- Stop
- 2011-08-11
The parties
- Patient
- patient Sherlyn Clarice Schuppe
- Provider
- provider Ramiro Boehm
- Payer
- payer Medicaid
Record id
0b40911b-036e-86a4-b302-f47ff3000c6d