Claim total
$498.76
base $93.83 · payer covered $392.15
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1973-06-01
- Stop
- 1973-06-01
The parties
- Patient
- patient Ronnie Ina Gusikowski
- Provider
- provider Anneliese Bradtke
- Payer
- payer Medicaid
Record id
003b30a0-7fd2-f42c-0bce-b2c61248b24f