Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-03-07
- Stop
- 2018-03-07
The parties
- Patient
- patient Elden Winfred Glover
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
282fac41-00ac-b264-46a8-75644cc20894