Claim total
$838.28
base $93.83 · payer covered $738.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-12-04
- Stop
- 2011-12-04
The parties
- Patient
- patient Willian Mante
- Provider
- provider Venita Fahey
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Medicaid
Record id
1a965d90-6476-30d5-3fc7-4de91cf02df4