Claim total
$780.15
base $93.83 · payer covered $680.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-10-12
- Stop
- 2016-10-12
The parties
- Patient
- patient Eduardo Reuben Gutmann
- Provider
- provider Ramiro Boehm
- Payer
- payer Medicaid
Record id
2fc8278e-6ad0-aff8-5660-b44b651e751d