Claim total
$777.13
base $93.83 · payer covered $438.42
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-12-11
- Stop
- 2002-12-11
The parties
- Patient
- patient Lucia Eloisa Prado
- Provider
- provider Rodrick Moen
- Payer
- payer Medicare
Record id
130f657d-55b9-f148-bce2-53ac1052b08e