Claim total
$775.00
base $93.83 · payer covered $775.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-02-10
- Stop
- 2006-02-10
The parties
- Patient
- patient Nena Josephine Stehr
- Provider
- provider Eduardo Rubio
- Care site
- care site OPTAGE PRIMARY CARE LLC
- Payer
- payer Dual Eligible
Record id
00eec58c-8547-4a29-ca39-76bf032a2505