Claim total
$752.90
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-01-12
- Stop
- 2018-01-12
The parties
- Patient
- patient Cristina Caridad Salcedo
- Provider
- provider Magen Mertz
- Payer
- payer Humana
Record id
031e24ca-9978-b353-183c-58d03902bf0e