Claim total
$780.15
base $93.83 · payer covered $630.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1999-06-30
- Stop
- 1999-06-30
The parties
- Patient
- patient Grady Wayne Sauer
- Provider
- provider Randee Sawayn
- Payer
- payer Medicaid
Record id
39d4f819-e788-754b-5708-2bedac30c154