Claim total
$1,139.28
base $93.83 · payer covered $1,139.28
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-10-07
- Stop
- 2018-10-07
The parties
- Patient
- patient Abdul Sammie Spencer
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
009b9fb1-8515-f33d-d145-762dfb100b20