Claim total
$773.83
base $93.83 · payer covered $773.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2024-01-22
- Stop
- 2024-01-22
The parties
- Patient
- patient Cristy Pamella Moore
- Provider
- provider Sherwood Nicolas
- Payer
- payer Medicaid
Record id
012588b7-68ba-5ed1-9435-bed14591ee87