Claim total
$836.12
base $93.83 · payer covered $836.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-02-24
- Stop
- 2015-02-24
The parties
- Patient
- patient Dwain Colin Simonis
- Provider
- provider Florentino Boehm
- Payer
- payer Medicaid
Record id
0ed9a3cf-eb03-2b47-55e8-952c9d34e931