Claim total
$780.15
base $93.83 · payer covered $630.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1947-03-03
- Stop
- 1947-03-03
The parties
- Patient
- patient Elden Cary DuBuque
- Provider
- provider Hazel Effertz
- Payer
- payer Medicaid
Record id
2f6fe81f-21ca-2f76-6d2f-c929ce272c38