Claim total
$3,456.45
base $155.66 · payer covered $3,406.45
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2020-01-01
- Stop
- 2020-01-01
The parties
- Patient
- patient Sha Robin Reilly
- Provider
- provider Trinity Mraz
- Payer
- payer Medicaid
Record id
043d6e13-0cc7-07f3-08d1-87be7db4f874