Claim total
$840.41
base $93.83 · payer covered $740.41
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2020-01-25
- Stop
- 2020-01-25
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Kenneth Mayert
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-bd7b-4d9705634f18