Claim total
$780.15
base $93.83 · payer covered $630.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-09-12
- Stop
- 2004-09-12
The parties
- Patient
- patient Romana Ziemann
- Provider
- provider Dan Leuschke
- Care site
- care site WELLNESS CENTERS, PLLC
- Payer
- payer Medicaid
Record id
16726cc8-c8a2-64af-bb6f-a93d8fec210f