Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1971-10-15
- Stop
- 1971-10-15
The parties
- Patient
- patient Ardith Jene Osinski
- Provider
- provider Leeann Padberg
- Care site
- care site MEDICAL CARE SERVICES, PA
- Payer
- payer Medicaid
Record id
39d634ce-fc5f-418c-1c20-d79aa54cd515