Claim total
$906.71
base $93.83 · payer covered $856.71
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-11-04
- Stop
- 1997-11-04
The parties
- Patient
- patient Salina Takako Ondricka
- Provider
- provider Nikia Mills
- Payer
- payer Medicaid
Record id
15541585-3618-a727-4836-581f2ab4d704