Claim total
$1,463.73
base $93.83 · payer covered $1,463.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-11-25
- Stop
- 2013-11-25
The parties
- Patient
- patient José Luis Esteban Palomo
- Provider
- provider Magen Mertz
- Payer
- payer Dual Eligible
Record id
2c5a4ef2-0007-8652-4d5f-96d44c36d3ce