Claim total
$838.28
base $93.83 · payer covered $688.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1956-03-12
- Stop
- 1956-03-12
The parties
- Patient
- patient Elden Cary DuBuque
- Provider
- provider Andria Spinka
- Payer
- payer Medicaid
Record id
2f6fe81f-21ca-2f76-7a74-c6c6b3519376