Claim total
$1,164.74
base $93.83 · payer covered $1,164.74
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-04-08
- Stop
- 2019-04-08
The parties
- Patient
- patient Coretta Philomena Boyle
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
06293262-0c72-c029-ca5e-8287b67a0ab4