Claim total
$1,457.75
base $93.83 · payer covered $1,457.75
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-01-04
- Stop
- 2020-01-04
The parties
- Provider
- provider Kelvin Reichel
- Payer
- payer Medicaid
Record id
03d1ce86-efe3-018d-9633-38770a0cfda1