Claim total
$1,443.56
base $93.83 · payer covered $1,443.56
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-08-27
- Stop
- 2019-08-27
The parties
- Patient
- patient Sherill Ingeborg Wyman
- Provider
- provider Ursula Nolan
- Payer
- payer Medicaid
Record id
03eccc4c-a1c4-14ad-3f5b-10101eaa65d3