Claim total
$1,449.77
base $93.83 · payer covered $1,393.16
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-10-25
- Stop
- 2014-10-25
The parties
- Patient
- patient Le Rosella Marks
- Provider
- provider Shani Carroll
- Payer
- payer Medicaid
Record id
08d0bbfe-3183-9cfc-9485-feea5fdfc859