Claim total
$711.72
base $93.83 · payer covered $711.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-01-27
- Stop
- 2024-01-27
The parties
- Provider
- provider Hazel Effertz
- Payer
- payer Medicaid
Record id
03d1ce86-efe3-018d-14b0-12a4e66c7953