Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-07-08
- Stop
- 1991-07-08
The parties
- Patient
- patient Adrian Isaiah Durgan
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
046903bc-0773-63cf-5ecb-71559c1d3eb2