Claim total
$982.59
base $93.83 · payer covered $882.59
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-02-05
- Stop
- 2022-02-05
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Kenneth Mayert
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-7437-3343bf424cd6