Claim total
$775.00
base $93.83 · payer covered $675.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-09-06
- Stop
- 2009-09-06
The parties
- Patient
- patient Angila Delfina Friesen
- Provider
- provider In Reichert
- Payer
- payer Medicaid
Record id
2fb62ca5-b037-fe29-6fcd-46d88f0b816f