Claim total
$843.43
base $93.83 · payer covered $793.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1974-02-10
- Stop
- 1974-02-10
The parties
- Patient
- patient Lanell Larson
- Provider
- provider Long Konopelski
- Care site
- care site SAMA HEALTH CARE
- Payer
- payer Medicaid
Record id
2a98f89f-76a4-67f9-b34c-75fa0d6e6a01