Claim total
$1,463.73
base $93.83 · payer covered $1,413.73
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1992-08-06
- Stop
- 1992-08-06
The parties
- Patient
- patient Delmar Hane
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
3a738417-6d7e-6b44-0e48-cf2c791a421f