Claim total
$1,776.21
base $93.83 · payer covered $1,741.21
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1980-07-20
- Stop
- 1980-07-20
The parties
- Patient
- patient Manuel Dusty Mitchell
- Provider
- provider Rodrick Moen
- Payer
- payer Dual Eligible
Record id
391ddd05-98fd-5656-2ac3-a16310e61506