Claim total
$1,722.00
base $93.83 · payer covered $653.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2000-03-30
- Stop
- 2000-03-30
The parties
- Patient
- patient Allene Jonell Stark
- Provider
- provider Sherwood Nicolas
- Payer
- payer UnitedHealthcare
Record id
39bdbcaa-0f4c-539e-62f7-fa8e81b306f9