Claim total
$704.41
base $93.83 · payer covered $559.39
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1952-01-24
- Stop
- 1952-01-24
The parties
- Patient
- patient Bob Sergio O'Hara
- Provider
- provider Kelvin Reichel
- Payer
- payer Medicaid
Record id
261c034c-cc44-5f0f-3eec-512bb05c1d8b