Claim total
$1,722.00
base $93.83 · payer covered $1,572.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1994-05-11
- Stop
- 1994-05-11
The parties
- Patient
- patient Edgar Herzog
- Provider
- provider Nikia Mills
- Payer
- payer Medicaid
Record id
1f5e460e-a26c-0249-2cac-e7e2f54ec8ac