Claim total
$1,137.75
base $93.83 · payer covered $1,087.75
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1975-06-13
- Stop
- 1975-06-13
The parties
- Patient
- patient Ronnie Ina Gusikowski
- Provider
- provider Jared Berge
- Payer
- payer Medicaid
Record id
003b30a0-7fd2-f42c-7a20-c6b2df0359cb