Claim total
$641.13
base $93.83 · payer covered $591.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1960-06-16
- Stop
- 1960-06-16
The parties
- Patient
- patient Lamar Mark Connelly
- Provider
- provider Jared Berge
- Payer
- payer Medicaid
Record id
050746ba-be7e-c592-6321-f361de7d7eb8