Claim total
$641.13
base $93.83 · payer covered $591.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-03-08
- Stop
- 1991-03-08
The parties
- Patient
- patient Danial Hal Lang
- Provider
- provider Shaunda Ledner
- Payer
- payer Medicaid
Record id
06067a48-9015-34d7-1911-e012349baa40