Claim total
$840.41
base $93.83 · payer covered $486.70
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-09-11
- Stop
- 2013-09-11
The parties
- Patient
- patient Kim Edmundo Rolfson
- Provider
- provider Rodrick Moen
- Payer
- payer Medicare
Record id
03d7ab8f-b989-4d49-70c6-2ff596638479