Claim total
$777.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2011-05-01
- Stop
- 2011-05-01
The parties
- Patient
- patient Xuan Collier
- Provider
- provider Shani Carroll
- Payer
- payer Humana
Record id
002d4429-df26-5797-c838-efaca0a0a443