Claim total
$704.41
base $93.83 · payer covered $563.52
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-08-08
- Stop
- 2007-08-08
The parties
- Patient
- patient Kim Edmundo Rolfson
- Provider
- provider Ursula Nolan
- Payer
- payer Medicare
Record id
03d7ab8f-b989-4d49-b572-a73fcc288eb3