Claim total
$15,483.21
base $93.39 · payer covered $15,448.21
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 1987-06-04
- Stop
- 1987-06-04
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Hazel Effertz
- Payer
- payer Dual Eligible
Record id
04371635-b149-02a5-5ea5-6267bd1a3ff1