Claim total
$846.78
base $93.83 · payer covered $811.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1959-06-02
- Stop
- 1959-06-02
The parties
- Provider
- provider Remona Sanford
- Payer
- payer Dual Eligible
Record id
0126321a-a5af-784d-3b64-b703b2f05b6b