Claim total
$978.26
base $155.66 · payer covered $928.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2016-12-26
- Stop
- 2016-12-26
The parties
- Patient
- patient Nana Earlean Kuphal
- Provider
- provider Marcus Douglas
- Payer
- payer Medicaid
Record id
01077a3b-80bd-4b83-72cd-de2b05f2b060