Claim total
$985.80
base $93.83 · payer covered $885.80
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-04-06
- Stop
- 2007-04-06
The parties
- Patient
- patient Lelia Ariana Metz
- Provider
- provider Adelia Dickens
- Care site
- care site WELLNESS CENTERS, PLLC
- Payer
- payer Medicaid
Record id
28793fbe-ecef-a924-3a17-46bdf3859ae2