Claim total
$229.83
base $93.83 · payer covered $229.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-11-20
- Stop
- 2025-11-20
The parties
- Patient
- patient Demetrius Fabian Fahey
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
011d229d-4683-9f9e-9c40-908388920293