Claim total
$1,129.28
base $93.83 · payer covered $903.42
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-10-21
- Stop
- 2015-10-21
The parties
- Patient
- patient Shon Cesar Ebert
- Provider
- provider Magen Mertz
- Payer
- payer Medicare
Record id
03d8f92f-53db-d7af-69bf-027cdd58bc23