Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-08-31
- Stop
- 2004-08-31
The parties
- Patient
- patient Cecil Smith
- Provider
- provider Hazel Effertz
- Payer
- payer Medicaid
Record id
29d86494-f39d-b250-e2ec-402348d1c4a1