Claim total
$1,251.71
base $93.83 · payer covered $1,251.71
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-05-06
- Stop
- 2006-05-06
The parties
- Patient
- patient Jody Kevin Schulist
- Provider
- provider Elbert Schaefer
- Payer
- payer Dual Eligible
Record id
130e8d27-265d-dd8f-07b6-ba6a6978771c