Claim total
$1,104.29
base $93.83 · payer covered $1,054.29
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1947-10-20
- Stop
- 1947-10-20
The parties
- Patient
- patient Raylene Edris Parisian
- Provider
- provider Wesley Nader
- Payer
- payer Medicaid
Record id
298344b3-dd31-0e7f-4af2-108cdb566f65