Claim total
$1,123.02
base $93.83 · payer covered $1,088.02
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-10-02
- Stop
- 1997-10-02
The parties
- Patient
- patient Christy Lonnie Dare
- Provider
- provider Venita Fahey
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Dual Eligible
Record id
07310d81-b798-6d62-13b7-5d3d3f8dca61