Claim total
$704.41
base $93.83 · payer covered $554.41
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1968-09-17
- Stop
- 1968-09-17
The parties
- Patient
- patient Erick Dee Langworth
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
238d0bff-6fe3-978f-5a28-9b8ee16c9601