Claim total
$10,497.70
base $93.83 · payer covered $10,462.70
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1992-04-14
- Stop
- 1992-04-14
The parties
- Provider
- provider Remona Sanford
- Payer
- payer Dual Eligible
Record id
0126321a-a5af-784d-7a36-2017842823be