Claim total
$843.43
base $93.83 · payer covered $843.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-03-03
- Stop
- 2017-03-03
The parties
- Patient
- patient Bryon Rolfson
- Provider
- provider Remona Sanford
- Payer
- payer Dual Eligible
Record id
1ff61b1b-1a9a-8009-a17b-39a393cf0601