Claim total
$365.83
base $93.83 · payer covered $215.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1967-04-28
- Stop
- 1967-04-28
The parties
- Patient
- patient Ronnie Ina Gusikowski
- Provider
- provider Julene Lemke
- Payer
- payer Medicaid
Record id
003b30a0-7fd2-f42c-afa8-5f24a3fa7732