Claim total
$1,115.71
base $93.83 · payer covered $1,115.71
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-10-17
- Stop
- 2017-10-17
The parties
- Patient
- patient Evangeline Kasha Schaden
- Provider
- provider Nenita Glover
- Care site
- care site CENTRAL FAMILY CLINIC PLLC
- Payer
- payer Medicaid
Record id
0632026e-bab4-0d77-5b9f-4637a1565574