Claim total
$1,390.73
base $93.83 · payer covered $1,390.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-06-27
- Stop
- 2015-06-27
The parties
- Patient
- patient Jody Kevin Schulist
- Provider
- provider Elbert Schaefer
- Payer
- payer Dual Eligible
Record id
130e8d27-265d-dd8f-82fc-886c1e852d0a