Claim total
$704.41
base $93.83 · payer covered $669.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-08-30
- Stop
- 1991-08-30
The parties
- Provider
- provider Sheldon Graham
- Care site
- care site SAMA HEALTH CARE
- Payer
- payer Dual Eligible
Record id
2c186144-fcb7-debf-58ce-f931090237df