Claim total
$1,211.22
base $93.83 · payer covered $1,111.22
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-01-18
- Stop
- 2015-01-18
The parties
- Patient
- patient Adrian Grady O'Keefe
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
00a9bdc8-6b4d-5df7-0aad-6ca461846de6