Claim total
$780.15
base $93.83 · payer covered $680.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-06-10
- Stop
- 2006-06-10
The parties
- Patient
- patient Alica Tracie Gottlieb
- Provider
- provider Lowell Blick
- Payer
- payer Medicaid
Record id
384ec93e-e42b-5355-f1ff-d85fa4a1c18f