Claim total
$1,064.44
base $93.83 · payer covered $752.90
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-11-19
- Stop
- 2025-11-19
The parties
- Patient
- patient Kim Edmundo Rolfson
- Provider
- provider Rodrick Moen
- Payer
- payer Medicare
Record id
03d7ab8f-b989-4d49-a04d-21d07ae3a98a