Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1949-05-25
- Stop
- 1949-05-25
The parties
- Patient
- patient Shon Cesar Ebert
- Provider
- provider Remona Sanford
- Payer
- payer No insurance
Record id
03d8f92f-53db-d7af-e273-dbedbbbf1912