Claim total
$1,491.77
base $93.83 · payer covered $1,341.77
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2001-01-25
- Stop
- 2001-01-25
The parties
- Patient
- patient Audie Akiko Brakus
- Provider
- provider Rodrick Willms
- Care site
- care site CENTRAL FAMILY CLINIC PLLC
- Payer
- payer Medicaid
Record id
2cc6ebbd-677c-12d9-ae8c-23c390090039