Claim total
$11,220.07
base $93.83 · payer covered $11,185.07
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-05-13
- Stop
- 1997-05-13
The parties
- Provider
- provider Magen Mertz
- Payer
- payer Dual Eligible
Record id
0126321a-a5af-784d-39bb-6cbfc4a12490