Claim total
$846.78
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-01-06
- Stop
- 2017-01-06
The parties
- Patient
- patient Cristina Caridad Salcedo
- Provider
- provider Magen Mertz
- Payer
- payer Humana
Record id
031e24ca-9978-b353-5679-46f5cb279a51