Claim total
$775.00
base $93.83 · payer covered $465.87
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-11-07
- Stop
- 2018-11-07
The parties
- Patient
- patient Shon Cesar Ebert
- Provider
- provider Remona Sanford
- Payer
- payer Medicare
Record id
03d8f92f-53db-d7af-fe6b-bc525515a727