Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-04-16
- Stop
- 2024-04-16
The parties
- Patient
- patient An Wenona Rau
- Provider
- provider Jared Berge
- Payer
- payer Medicaid
Record id
04682680-f77d-0a00-23bf-63346357ab86