Claim total
$767.69
base $93.83 · payer covered $732.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-08-06
- Stop
- 1991-08-06
The parties
- Patient
- patient Chantelle Colby Dibbert
- Provider
- provider Magen Mertz
- Payer
- payer Dual Eligible
Record id
23b0353c-2171-2057-1556-cb90a2ec0fc9