Claim total
$1,293.94
base $93.83 · payer covered $1,193.94
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-07-28
- Stop
- 2022-07-28
The parties
- Patient
- patient Hien Shasta Nikolaus
- Provider
- provider Sang Bernier
- Payer
- payer Medicaid
Record id
1feed5c5-ef44-d1c7-1ca5-1f560c90b297