Claim total
$1,313.77
base $93.83 · payer covered $1,213.77
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-10-27
- Stop
- 2014-10-27
The parties
- Patient
- patient Renda Sonya MacGyver
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
3502b5eb-e4fe-8ea0-158e-7c50302046dc