Claim total
$979.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2008-07-19
- Stop
- 2008-07-19
The parties
- Patient
- patient Stewart Dean Pouros
- Provider
- provider Valda Fritsch
- Payer
- payer Humana
Record id
1135afcc-5534-4bcf-1a27-553d9409de1e