Claim total
$843.43
base $93.83 · payer covered $843.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-08-31
- Stop
- 2009-08-31
The parties
- Patient
- patient Celestina Angle Mohr
- Provider
- provider Shani Carroll
- Payer
- payer Medicaid
Record id
30331ffd-6cb2-e716-df8f-be783dfea6eb