Claim total
$767.69
base $93.83 · payer covered $767.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-03-27
- Stop
- 2015-03-27
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Jared Berge
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-2415-70d50d0bd766