Claim total
$1,116.65
base $93.83 · payer covered $1,016.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-09-02
- Stop
- 2013-09-02
The parties
- Patient
- patient Adrian Isaiah Durgan
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
046903bc-0773-63cf-82b0-d10bd5c1272b