Claim total
$641.13
base $93.83 · payer covered $591.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-04-09
- Stop
- 2022-04-09
The parties
- Patient
- patient Zachery Vincenzo Berge
- Provider
- provider Ursula Nolan
- Payer
- payer Medicaid
Record id
01ce818c-8f9f-924a-1914-31f0567b4a06