Claim total
$979.43
base $93.83 · payer covered $944.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1983-01-18
- Stop
- 1983-01-18
The parties
- Patient
- patient Elton Pierre Cummerata
- Provider
- provider Hazel Effertz
- Payer
- payer Dual Eligible
Record id
10e19c97-2fb2-0e88-578e-17f6d05def0b