Claim total
$1,303.36
base $93.83 · payer covered $1,253.36
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1984-07-02
- Stop
- 1984-07-02
The parties
- Patient
- patient Jeramy Quitzon
- Provider
- provider Andria Spinka
- Payer
- payer Medicaid
Record id
39ff36a1-4189-afbb-bc38-0e5d2bd5fb84