Claim total
$711.72
base $93.83 · payer covered $611.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-06-05
- Stop
- 2023-06-05
The parties
- Patient
- patient Josue Joaquin Nicolas
- Provider
- provider Jared Berge
- Payer
- payer Medicaid
Record id
18b3ccbc-153b-4ee3-616e-8ee0900cea50