Claim total
$1,252.65
base $93.83 · payer covered $1,152.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-02-10
- Stop
- 2016-02-10
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Jared Berge
- Payer
- payer Medicaid
Record id
00e3929f-91f8-0715-2666-ed02a4e49aa1