Claim total
$775.00
base $93.83 · payer covered $449.34
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-04-03
- Stop
- 2025-04-03
The parties
- Patient
- patient Joan Donnie Quitzon
- Provider
- provider Magen Mertz
- Payer
- payer Medicare
Record id
056f2732-3438-a432-71bd-4855dc750523