Claim total
$1,171.69
base $93.83 · payer covered $1,171.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-02-10
- Stop
- 2026-02-10
The parties
- Patient
- patient Elton Pierre Cummerata
- Provider
- provider Rosio Gleason
- Payer
- payer Dual Eligible
Record id
10e19c97-2fb2-0e88-552a-1ba023898778