Claim total
$767.69
base $93.83 · payer covered $667.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-02-23
- Stop
- 2018-02-23
The parties
- Patient
- patient Penni Oscar Blanda
- Provider
- provider Shani Carroll
- Payer
- payer Medicaid
Record id
28340124-bedf-918d-c95b-9961eb9accb2