Claim total
$293.11
base $93.83 · payer covered $193.11
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2023-10-16
- Stop
- 2023-10-16
The parties
- Patient
- patient Cristy Pamella Moore
- Provider
- provider Ruben Farrell
- Payer
- payer Medicaid
Record id
012588b7-68ba-5ed1-0a40-0ef36bc1e0bd