Claim total
$1,665.44
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-04-04
- Stop
- 2022-04-04
The parties
- Patient
- patient Leif Darren West
- Provider
- provider Ursula Nolan
- Payer
- payer Humana
Record id
04bc601b-5b17-3710-7a17-f43e3a459fd0