Claim total
$972.12
base $93.83 · payer covered $822.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2000-04-16
- Stop
- 2000-04-16
The parties
- Patient
- patient Quintin Loyd Ullrich
- Provider
- provider Hazel Effertz
- Payer
- payer Medicaid
Record id
33a68753-f79f-bb9d-806c-6714f066a032