Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2023-04-18
- Stop
- 2023-04-18
The parties
- Patient
- patient Nicky Kristi Wiegand
- Provider
- provider Venita Fahey
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Medicaid
Record id
0358d022-e88b-b208-43b4-32ecd5a2876d