Claim total
$1,251.43
base $93.83 · payer covered $1,251.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-02-08
- Stop
- 2018-02-08
The parties
- Patient
- patient Jeanice Rene Upton
- Provider
- provider Adelia Dickens
- Care site
- care site WELLNESS CENTERS, PLLC
- Payer
- payer Medicaid
Record id
393ec674-f74f-a54b-0556-d823e46119a9