Claim total
$1,115.71
base $93.83 · payer covered $1,015.71
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-12-24
- Stop
- 2017-12-24
The parties
- Patient
- patient Danyell Anya Gislason
- Provider
- provider Phylis Lind
- Payer
- payer Medicaid
Record id
00b8faa9-dae2-fa2d-77a8-6ba91dc70125