Claim total
$972.12
base $93.83 · payer covered $872.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-01-28
- Stop
- 2026-01-28
The parties
- Provider
- provider Ursula Nolan
- Payer
- payer Medicaid
Record id
1b4b3772-3827-eee9-5ebe-a598aa08633b