Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-02-01
- Stop
- 2025-02-01
The parties
- Patient
- patient Harry Will Streich
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
0399299d-024a-c139-5eba-ae370e74b4c5