Claim total
$787.46
base $93.83 · payer covered $637.46
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1961-06-22
- Stop
- 1961-06-22
The parties
- Patient
- patient Lamar Mark Connelly
- Provider
- provider Jared Berge
- Payer
- payer Medicaid
Record id
050746ba-be7e-c592-9bf1-54c0db69bc85