Claim total
$919.59
base $93.83 · payer covered $819.59
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-08-19
- Stop
- 2012-08-19
The parties
- Patient
- patient Joie Lubowitz
- Provider
- provider Rodrick Moen
- Payer
- payer Medicaid
Record id
361510b3-a9f5-9a93-4488-a2d0f34de986