Claim total
$1,112.36
base $93.83 · payer covered $1,012.36
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-02-17
- Stop
- 2017-02-17
The parties
- Patient
- patient Penni Oscar Blanda
- Provider
- provider Shani Carroll
- Payer
- payer Medicaid
Record id
28340124-bedf-918d-841a-e7d1985204c9