Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-03-18
- Stop
- 2026-03-18
The parties
- Patient
- patient Amanda Rheba Mitchell
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
0363ed75-83f4-7675-5244-fb9e005c33d0