Claim total
$767.69
base $93.83 · payer covered $767.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-04-01
- Stop
- 2014-04-01
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Nikia Mills
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-29a1-8a7923e05c60