Claim total
$1,352.38
base $93.83 · payer covered $1,202.38
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1999-05-30
- Stop
- 1999-05-30
The parties
- Patient
- patient Denyse Fadel
- Provider
- provider Shani Carroll
- Payer
- payer Medicaid
Record id
048ae427-86b6-6ce9-877a-a3b68fac409b