Claim total
$846.78
base $93.83 · payer covered $846.78
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2021-11-25
- Stop
- 2021-11-25
The parties
- Patient
- patient Royce Peter Wolf
- Provider
- provider Remona Sanford
- Payer
- payer Dual Eligible
Record id
04658673-6112-6940-be35-3f1a80e3e846