Claim total
$229.83
base $93.83 · payer covered $229.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-09-22
- Stop
- 2025-09-22
The parties
- Patient
- patient Cristy Pamella Moore
- Provider
- provider Ruben Farrell
- Payer
- payer Medicaid
Record id
012588b7-68ba-5ed1-3838-9d3d3422dc77