Claim total
$1,526.73
base $93.83 · payer covered $1,491.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-12-17
- Stop
- 2003-12-17
The parties
- Patient
- patient Lucia Eloisa Prado
- Provider
- provider Elbert Schaefer
- Payer
- payer Dual Eligible
Record id
130f657d-55b9-f148-d3c8-09b4d022d896