Claim total
$847.72
base $93.83 · payer covered $847.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-10-30
- Stop
- 2023-10-30
The parties
- Patient
- patient Adrian Isaiah Durgan
- Provider
- provider Randee Sawayn
- Payer
- payer Dual Eligible
Record id
046903bc-0773-63cf-44d6-26a5cf29b50b