Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1972-12-21
- Stop
- 1972-12-21
The parties
- Patient
- patient Gwyn Andria Jakubowski
- Provider
- provider Remona Sanford
- Payer
- payer Humana
Record id
1d7176d6-ddf2-55da-8070-48b7866d2b8d