Claim total
$775.00
base $93.83 · payer covered $775.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-02-03
- Stop
- 2015-02-03
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Nestor Kling
- Payer
- payer Medicaid
Record id
03f9d33d-12ca-f1a8-e7d8-8c6b4a1c4ea9