Claim total
$1,138.68
base $93.83 · payer covered $1,038.68
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-06-09
- Stop
- 2011-06-09
The parties
- Patient
- patient Cathryn Kandy Smith
- Provider
- provider Pearly Rohan
- Payer
- payer Medicaid
Record id
038ad96a-9908-2f0d-93e3-7b22a4cdeb69