Claim total
$5,446.49
base $93.83 · payer covered $4,357.19
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-12-09
- Stop
- 2004-12-09
The parties
- Patient
- patient Joan Donnie Quitzon
- Provider
- provider Remona Sanford
- Payer
- payer Medicare
Record id
056f2732-3438-a432-816f-1a85720d8fc8