Claim total
$978.49
base $93.83 · payer covered $828.49
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-11-21
- Stop
- 2005-11-21
The parties
- Patient
- patient Quentin Julius Roberts
- Provider
- provider Fatimah Schumm
- Payer
- payer Medicaid
Record id
352df3b7-7347-fd8e-a4ef-7b72be5a9d8e