Claim total
$1,771.20
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-05-21
- Stop
- 2004-05-21
The parties
- Patient
- patient Fermin Legros
- Provider
- provider Hazel Effertz
Record id
062f00f9-5db0-55c4-fde6-69061956083e