Claim total
$1,305.55
base $93.83 · payer covered $1,305.55
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-01-26
- Stop
- 2011-01-26
The parties
- Patient
- patient Cedrick Heath Rosenbaum
- Provider
- provider Robbi Stark
- Payer
- payer Dual Eligible
Record id
03eafe4d-23cd-eb61-8157-e673b8802c0d