Claim total
$575.72
base $93.83 · payer covered $575.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-09-01
- Stop
- 2021-09-01
The parties
- Patient
- patient Edgar Herzog
- Provider
- provider Randee Sawayn
- Payer
- payer Dual Eligible
Record id
1f5e460e-a26c-0249-0654-29700a0ed7b7