Claim total
$1,147.31
base $93.83 · payer covered $1,097.31
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1995-03-31
- Stop
- 1995-03-31
The parties
- Patient
- patient Marvel Ashlie Reichert
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
3240793b-3c82-d1b6-2b06-ca16c71d34e7