Claim total
$976.41
base $93.83 · payer covered $826.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-02-16
- Stop
- 2004-02-16
The parties
- Patient
- patient Marisa Tracee Botsford
- Provider
- provider Robin Stokes
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
0f07e26f-2898-bd8c-fea5-7d05fe829832