Claim total
$3,908.05
base $93.83 · payer covered $3,858.05
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1999-05-25
- Stop
- 1999-05-25
The parties
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
0126321a-a5af-784d-1cab-2ea2f6293bd0