Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1971-11-11
- Stop
- 1971-11-11
The parties
- Patient
- patient Christy Lonnie Dare
- Provider
- provider Shaun Hills
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Medicaid
Record id
07310d81-b798-6d62-e5cb-d656775e2145