Claim total
$775.00
base $93.83 · payer covered $725.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1970-06-26
- Stop
- 1970-06-26
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Jared Berge
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-d264-b2ef95f12927