Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-06-04
- Stop
- 2011-06-04
The parties
- Patient
- patient Louis Lowe
- Provider
- provider Maryjane Farrell
- Payer
- payer Humana
Record id
0133e229-9af3-5afb-bfe2-8372cb4b8d49