Claim total
$772.84
base $93.83 · payer covered $772.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-06-10
- Stop
- 2015-06-10
The parties
- Patient
- patient Jay Gerardo Bernhard
- Provider
- provider Elbert Schaefer
- Payer
- payer Dual Eligible
Record id
295a8330-1c69-d856-0f45-3efe09b2fc32