Claim total
$13,489.73
base $93.83 · payer covered $13,389.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2008-02-24
- Stop
- 2008-02-24
The parties
- Patient
- patient Harris Darin Mills
- Provider
- provider Ramiro Boehm
- Payer
- payer Medicaid
Record id
1e9a2bb2-1f89-235a-50bb-487b25270331