Claim total
$505.13
base $93.83 · payer covered $405.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-11-08
- Stop
- 2018-11-08
The parties
- Patient
- patient Royce Peter Wolf
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
04658673-6112-6940-bc90-abbb2d451bee