Claim total
$1,341.84
base $93.83 · payer covered $1,306.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-09-17
- Stop
- 2005-09-17
The parties
- Patient
- patient Blanche Bernier
- Provider
- provider Brenda Moore
- Payer
- payer Dual Eligible
Record id
2c01101e-9e7a-a6ae-436b-a50c4e343505