Claim total
$978.26
base $155.66 · payer covered $828.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2019-09-10
- Stop
- 2019-09-10
The parties
- Patient
- patient Mirta Nakisha Franecki
- Provider
- provider Leta Sipes
- Payer
- payer Medicaid
Record id
05902870-85f1-fda1-3b9f-876ee02f7b47