Claim total
$1,321.36
base $93.83 · payer covered $870.68
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-09-19
- Stop
- 2014-09-19
The parties
- Patient
- patient Rosario Jim Braun
- Provider
- provider Hazel Effertz
- Payer
- payer Medicare
Record id
023d14fa-8b29-07fb-6d19-c1bd58213ed3