Claim total
$773.83
base $93.83 · payer covered $773.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-05-03
- Stop
- 2025-05-03
The parties
- Patient
- patient Marsha Dodie Kuvalis
- Provider
- provider Sage Schiller
- Care site
- care site SAMA HEALTH CARE
- Payer
- payer Medicaid
Record id
062d51e6-50d3-3fdf-fa3f-c342eb762878