Claim total
$694.97
base $93.83 · payer covered $644.97
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-07-09
- Stop
- 2003-07-09
The parties
- Patient
- patient Gene Erin Wehner
- Provider
- provider Hazel Effertz
- Payer
- payer Medicaid
Record id
0324eea5-bb16-c29a-b83f-e6a374284521