Claim total
$229.83
base $93.83 · payer covered $129.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-04-13
- Stop
- 2019-04-13
The parties
- Patient
- patient Shalon Arnetta Bosco
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
03f768f4-038d-f7fd-ed8b-8834acf15ac8