Claim total
$704.41
base $93.83 · payer covered $554.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1963-09-26
- Stop
- 1963-09-26
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Kelvin Reichel
- Payer
- payer Medicaid
Record id
04371635-b149-02a5-ce0d-59e842117b4c