Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2022-12-01
- Stop
- 2022-12-01
The parties
- Patient
- patient Royce Peter Wolf
- Provider
- provider Remona Sanford
- Payer
- payer Dual Eligible
Record id
04658673-6112-6940-92b6-89d0b8c8625a