Claim total
$1,039.64
base $93.83 · payer covered $1,039.64
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-03-20
- Stop
- 2011-03-20
The parties
- Patient
- patient Gilbert Ivan Bauch
- Provider
- provider Danica Stracke
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer Medicaid
Record id
0c35b5fe-1f15-f1f3-0c05-eb34693b52c3