Claim total
$1,112.41
base $93.83 · payer covered $1,012.41
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2014-12-27
- Stop
- 2014-12-27
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Kenneth Mayert
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-1d6e-5cf7b46c4176