Claim total
$775.00
base $93.83 · payer covered $775.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-11-10
- Stop
- 2025-11-10
The parties
- Patient
- patient Adrian Isaiah Durgan
- Provider
- provider Randee Sawayn
- Payer
- payer Dual Eligible
Record id
046903bc-0773-63cf-a7f8-d994b6ea2e26