Claim total
$840.41
base $93.83 · payer covered $504.25
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-01-02
- Stop
- 2009-01-02
The parties
- Patient
- patient Marilynn Jaimie Pouros
- Provider
- provider Elbert Schaefer
- Payer
- payer Humana
Record id
0126af27-a469-d3f6-ac14-8babb662704a