Claim total
$845.59
base $93.83 · payer covered $810.59
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-05-28
- Stop
- 2004-05-28
The parties
- Patient
- patient Waltraud Lily Yundt
- Provider
- provider Hazel Effertz
- Payer
- payer Dual Eligible
Record id
1f58a428-477a-27c1-c1ed-661675a8f025