Claim total
$846.78
base $93.83 · payer covered $846.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-03-19
- Stop
- 2011-03-19
The parties
- Patient
- patient Jeremy Gregory Jacobson
- Provider
- provider Randee Sawayn
Record id
04f9baea-0c64-12b2-fc90-87afab4b9f3e