Claim total
$1,005.54
base $93.83 · payer covered $905.54
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-11-01
- Stop
- 2025-11-01
The parties
- Patient
- patient Marsha Dodie Kuvalis
- Provider
- provider Long Konopelski
- Care site
- care site SAMA HEALTH CARE
- Payer
- payer Medicaid
Record id
062d51e6-50d3-3fdf-22b1-7cb2c0d28f2d