Claim total
$758.25
base $93.83 · payer covered $758.25
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-03-29
- Stop
- 2013-03-29
The parties
- Patient
- patient Nena Josephine Stehr
- Provider
- provider Eduardo Rubio
- Care site
- care site OPTAGE PRIMARY CARE LLC
- Payer
- payer Dual Eligible
Record id
00eec58c-8547-4a29-aa53-619a6ebf3569