Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-10-19
- Stop
- 2010-10-19
The parties
- Patient
- patient Rose Enola Mann
- Provider
- provider Hazel Effertz
- Payer
- payer Anthem
Record id
0e253527-504c-e850-4b08-acea02b1ce35