Claim total
$1,052.59
base $93.83 · payer covered $952.59
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-01-07
- Stop
- 2017-01-07
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Kenneth Mayert
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-f792-384318055e0a