Claim total
$1,344.40
base $93.83 · payer covered $1,075.51
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-06-29
- Stop
- 2014-06-29
The parties
- Patient
- patient Denyse Fadel
- Provider
- provider Shani Carroll
- Payer
- payer Anthem
Record id
048ae427-86b6-6ce9-6bcb-1ef2d501c447