Claim total
$775.00
base $93.83 · payer covered $625.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1958-01-04
- Stop
- 1958-01-04
The parties
- Patient
- patient Ethan Cary Abernathy
- Provider
- provider Shaunda Ledner
- Payer
- payer Medicaid
Record id
36047b27-9044-b82c-626a-41c839b99542