Claim total
$846.78
base $93.83 · payer covered $696.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1967-09-14
- Stop
- 1967-09-14
The parties
- Patient
- patient Sumiko Bethann Baumbach
- Provider
- provider David Klein
- Payer
- payer Medicaid
Record id
23c570a1-24f2-7527-ccac-e202b9c6d3e7