Claim total
$991.22
base $93.83 · payer covered $891.22
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-04-19
- Stop
- 2025-04-19
The parties
- Patient
- patient Alica Tracie Gottlieb
- Provider
- provider Jared Berge
- Payer
- payer Medicaid
Record id
384ec93e-e42b-5355-7b10-61766475fe53