Claim total
$843.43
base $93.83 · payer covered $808.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1972-06-20
- Stop
- 1972-06-20
The parties
- Provider
- provider Magen Mertz
- Payer
- payer Dual Eligible
Record id
0126321a-a5af-784d-8664-c2dc6b21dc75