Claim total
$1,185.08
base $93.83 · payer covered $1,085.08
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-11-15
- Stop
- 2016-11-15
The parties
- Patient
- patient Ayako Tynisha Konopelski
- Provider
- provider Phylis Lind
- Payer
- payer Medicaid
Record id
2d5fef92-5b93-765b-06a8-f3ae93dbef48