Claim total
$976.41
base $93.83 · payer covered $941.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1994-02-09
- Stop
- 1994-02-09
The parties
- Patient
- patient Jay Gerardo Bernhard
- Provider
- provider Rodrick Moen
- Payer
- payer Dual Eligible
Record id
295a8330-1c69-d856-a955-b50a4f0edab2