Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-11-20
- Stop
- 2021-11-20
The parties
- Patient
- patient Gerardo Marvin Johns
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
01513b97-46a6-1303-2234-03c245f612f3