Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-03-15
- Stop
- 2010-03-15
The parties
- Patient
- patient Rosaria Golden Bashirian
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
015dd051-d88b-0f3d-2af5-4327ed6a0fda