Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-03-23
- Stop
- 2019-03-23
The parties
- Patient
- patient Zachery Vincenzo Berge
- Provider
- provider Rodrick Moen
- Payer
- payer Medicaid
Record id
01ce818c-8f9f-924a-d93f-80e4ce959ba7