Claim total
$836.12
base $93.83 · payer covered $786.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1964-01-19
- Stop
- 1964-01-19
The parties
- Patient
- patient Kassie Freeda Mann
- Provider
- provider Long Konopelski
- Care site
- care site SAMA HEALTH CARE
- Payer
- payer Medicaid
Record id
20e03f0e-0182-78e0-122c-dbce41946958