Claim total
$6,060.31
base $93.83 · payer covered $6,025.31
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1996-05-07
- Stop
- 1996-05-07
The parties
- Provider
- provider Remona Sanford
- Payer
- payer Dual Eligible
Record id
0126321a-a5af-784d-b8f7-313460a0189c