Claim total
$1,116.65
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-10-15
- Stop
- 2010-10-15
The parties
- Patient
- patient Queenie Van Keebler
- Provider
- provider Sherwood Nicolas
- Payer
- payer Humana
Record id
046b1f1e-c36f-c080-e92a-1a004c70417d