Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-01-20
- Stop
- 2011-01-20
The parties
- Patient
- patient Isiah Dave Hickle
- Provider
- provider Sherwood Nicolas
- Payer
- payer Humana
Record id
1d8529de-749e-5c35-deeb-3e1a4754a8d0