Claim total
$5,303.85
base $93.83 · payer covered $5,203.85
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-05-05
- Stop
- 2010-05-05
The parties
- Patient
- patient Arnold Guillermo Parker
- Provider
- provider Ruben Farrell
- Payer
- payer Medicaid
Record id
27f92d06-19f5-0088-bb23-917399721bdc