Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1963-05-09
- Stop
- 1963-05-09
The parties
- Provider
- provider Randee Sawayn
- Payer
- payer No insurance
Record id
1f156774-6ac9-1ef9-a958-a2cf1e456879