Claim total
$1,597.60
base $93.83 · payer covered $1,447.60
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1977-05-17
- Stop
- 1977-05-17
The parties
- Patient
- patient Chantelle Colby Dibbert
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
23b0353c-2171-2057-9662-159be4208566