Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-09-30
- Stop
- 2012-09-30
The parties
- Patient
- patient Irvin Anibal Jenkins
- Provider
- provider Shani Carroll
- Payer
- payer Medicaid
Record id
0a444a8e-d682-af54-d8b2-1850d740fec2