Claim total
$775.00
base $93.83 · payer covered $675.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-06-13
- Stop
- 2013-06-13
The parties
- Patient
- patient Cathryn Kandy Smith
- Provider
- provider Pearly Rohan
- Payer
- payer Medicaid
Record id
038ad96a-9908-2f0d-f6e5-6a99ca413d4a