Claim total
$3,971.33
base $93.83 · payer covered $3,971.33
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-05-09
- Stop
- 2018-05-09
The parties
- Patient
- patient Shaina Wolff
- Provider
- provider Shenna Metz
- Care site
- care site CENTRAL FAMILY CLINIC PLLC
- Payer
- payer Dual Eligible
Record id
131b868f-c77f-95c7-070d-6d7aca34129f