Claim total
$775.00
base $93.83 · payer covered $675.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-05-19
- Stop
- 2017-05-19
The parties
- Patient
- patient Kyla Ivory Mante
- Provider
- provider Sherly Hodkiewicz
- Payer
- payer Medicaid
Record id
2c91feaf-a1cd-fb10-7e29-fd11b3c7469b