Claim total
$844.65
base $93.83 · payer covered $844.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-09-19
- Stop
- 2016-09-19
The parties
- Patient
- patient Adrian Isaiah Durgan
- Provider
- provider Randee Sawayn
- Payer
- payer Dual Eligible
Record id
046903bc-0773-63cf-f38e-597c00c99020