Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2021-04-24
- Stop
- 2021-04-24
The parties
- Patient
- patient Shalon Arnetta Bosco
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
03f768f4-038d-f7fd-8a39-39a70e456287