Claim total
$836.12
base $93.83 · payer covered $836.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-05-09
- Stop
- 2024-05-09
The parties
- Patient
- patient Estella Mirna Gislason
- Provider
- provider Robin Stokes
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
2c8b399e-e3cb-1b58-2760-5649905abac4