Claim total
$1,112.41
base $93.83 · payer covered $1,112.41
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-11-14
- Stop
- 2019-11-14
The parties
- Patient
- patient Royce Peter Wolf
- Provider
- provider Remona Sanford
- Payer
- payer Dual Eligible
Record id
04658673-6112-6940-bb53-12117f18c639