Claim total
$787.76
base $93.83 · payer covered $737.76
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1975-11-16
- Stop
- 1975-11-16
The parties
- Patient
- patient Lesia Catalina Ledner
- Provider
- provider In Reichert
- Payer
- payer Medicaid
Record id
058279b6-7701-4823-0f83-502b2d6dd8f7