Claim total
$1,049.08
base $93.83 · payer covered $1,014.08
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1963-06-29
- Stop
- 1963-06-29
The parties
- Patient
- patient Ellis Gary Cronin
- Provider
- provider Hazel Effertz
- Payer
- payer Dual Eligible
Record id
0c89b8f2-1b95-b082-a44a-1b81328469a0