Claim total
$4,036.74
base $93.83 · payer covered $3,886.74
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1987-10-29
- Stop
- 1987-10-29
The parties
- Patient
- patient Elijah Ellis Skiles
- Provider
- provider Ursula Nolan
- Payer
- payer Medicaid
Record id
29599f43-c6ee-475e-357f-5528786bb805