Claim total
$843.43
base $93.83 · payer covered $743.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-03-06
- Stop
- 2018-03-06
The parties
- Patient
- patient Fredericka Eusebia Fadel
- Provider
- provider Ursula Nolan
- Payer
- payer Medicaid
Record id
241eb205-3dd5-3858-2d8c-07c73e80dd55