Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-04-23
- Stop
- 2018-04-24
The parties
- Patient
- patient Elliott Crooks
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
016f6acf-14e3-04d0-b5e2-5deddf62c560