Claim total
$1,078.80
base $93.83 · payer covered $978.80
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-04-01
- Stop
- 2011-04-01
The parties
- Patient
- patient Loren Stephan Bashirian
- Provider
- provider Jan Nicolas
- Payer
- payer Medicaid
Record id
16f948a1-fb12-6466-2c97-8027c4e49849