Claim total
$1,052.43
base $93.83 · payer covered $1,052.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-11-30
- Stop
- 2012-11-30
The parties
- Patient
- patient Abe Adolph Berge
- Provider
- provider In Reichert
- Payer
- payer Dual Eligible
Record id
035310e6-92e0-05c1-fbe5-69517f02fdb0