Claim total
$1,201.23
base $93.83 · payer covered $1,166.23
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-06-22
- Stop
- 1991-06-22
The parties
- Patient
- patient Elwood Eduardo Crooks
- Provider
- provider Ramiro Boehm
- Payer
- payer Dual Eligible
Record id
10be41c6-8ca0-2da8-58c5-1a932d2eae84