Claim total
$911.00
base $93.83 · payer covered $811.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-01-18
- Stop
- 2013-01-18
The parties
- Patient
- patient Danial Hal Lang
- Provider
- provider Shaunda Ledner
- Payer
- payer Medicaid
Record id
06067a48-9015-34d7-e626-e0af179d0d3f