Claim total
$1,115.43
base $93.83 · payer covered $965.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-11-07
- Stop
- 2004-11-07
The parties
- Patient
- patient Martin Chong Gerhold
- Provider
- provider Kenneth Mayert
- Payer
- payer Medicaid
Record id
2a9287c4-7bdc-d5bc-d8a3-ed4f2386f754