Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-05-29
- Stop
- 2016-05-29
The parties
- Patient
- patient Xuan Collier
- Provider
- provider Shani Carroll
- Payer
- payer Humana
Record id
002d4429-df26-5797-6120-76cb345a9953