Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1960-04-12
- Stop
- 1960-04-12
The parties
- Patient
- patient Chantelle Colby Dibbert
- Provider
- provider Remona Sanford
- Payer
- payer Medicaid
Record id
23b0353c-2171-2057-9ad8-cca9467b2ccf