Claim total
$767.69
base $93.83 · payer covered $617.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1998-07-11
- Stop
- 1998-07-11
The parties
- Patient
- patient Gerardo Marvin Johns
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
01513b97-46a6-1303-7425-bb2deed4390b