Claim total
$899.40
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-08-16
- Stop
- 2004-08-16
The parties
- Patient
- patient Elinore Lizeth Crist
- Provider
- provider Remona Sanford
- Payer
- payer No insurance
Record id
1c47d02d-0fef-9635-b122-f3fd5ed4d8e2