Claim total
$846.78
base $93.83 · payer covered $696.78
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1995-06-05
- Stop
- 1995-06-05
The parties
- Patient
- patient Adam Jones
- Provider
- provider Richard Carter
- Care site
- care site SAMA HEALTH CARE
- Payer
- payer Medicaid
Record id
00229130-e769-8779-f86e-2ba393820308