Claim total
$1,321.36
base $93.83 · payer covered $1,221.36
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-12-18
- Stop
- 2015-12-18
The parties
- Patient
- patient Abe Adolph Berge
- Provider
- provider In Reichert
- Payer
- payer Medicaid
Record id
035310e6-92e0-05c1-aa03-5552f96c59f4