Claim total
$1,115.43
base $93.83 · payer covered $965.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2001-07-23
- Stop
- 2001-07-23
The parties
- Patient
- patient Josue Joaquin Nicolas
- Provider
- provider Lowell Blick
- Payer
- payer Medicaid
Record id
18b3ccbc-153b-4ee3-ed4e-4efaf8827d8f