Claim total
$976.41
base $93.83 · payer covered $876.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-05-05
- Stop
- 2007-05-05
The parties
- Patient
- patient Scarlet Kendal Ledner
- Provider
- provider Florentino Boehm
- Payer
- payer Medicaid
Record id
372f1d7c-54ad-6683-a1da-741d107915bb