Claim total
$1,504.48
base $93.83 · payer covered $1,504.48
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2024-05-11
- Stop
- 2024-05-11
The parties
- Patient
- patient Shalon Arnetta Bosco
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
03f768f4-038d-f7fd-c7aa-65bb655a4af8