Claim total
$767.69
base $93.83 · payer covered $767.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-05-15
- Stop
- 2016-05-15
The parties
- Patient
- patient Alexander Alene Hahn
- Provider
- provider Maris Bauch
- Care site
- care site MEDICAL CARE SERVICES, PA
- Payer
- payer Medicaid
Record id
17cf073a-0b9a-0cc7-7fdf-fa1b7fc7a27d