Claim total
$846.78
base $93.83 · payer covered $846.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-12-23
- Stop
- 2017-12-23
The parties
- Provider
- provider Kenneth Mayert
- Payer
- payer Medicaid
Record id
03d1ce86-efe3-018d-4c09-b3dd0dd050ee