Claim total
$978.49
base $93.83 · payer covered $828.49
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2001-10-25
- Stop
- 2001-10-25
The parties
- Patient
- patient Pablo Adán Ayala
- Provider
- provider In Reichert
- Payer
- payer Medicaid
Record id
13927fe1-f295-7769-7826-b53554f5d337