Claim total
$1,159.03
base $93.83 · payer covered $1,059.03
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-10-05
- Stop
- 2021-10-05
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Nikia Mills
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-d967-610c65b9db8e