Claim total
$843.43
base $93.83 · payer covered $843.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-05-15
- Stop
- 2025-05-15
The parties
- Provider
- provider Ursula Nolan
- Payer
- payer Dual Eligible
Record id
25b691b1-c349-2bb7-36eb-bbd8f01fcc8b