Claim total
$704.41
base $93.83 · payer covered $563.52
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-08-30
- Stop
- 2006-08-30
The parties
- Patient
- patient Shon Cesar Ebert
- Provider
- provider Remona Sanford
- Payer
- payer Medicare
Record id
03d8f92f-53db-d7af-4761-6154677bc4e5