Claim total
$772.84
base $93.83 · payer covered $772.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-01-15
- Stop
- 2022-01-15
The parties
- Provider
- provider Kelvin Reichel
- Payer
- payer Medicaid
Record id
03d1ce86-efe3-018d-23b8-056133376240