Claim total
$229.83
base $93.83 · payer covered $79.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1971-05-21
- Stop
- 1971-05-21
The parties
- Patient
- patient Ronnie Ina Gusikowski
- Provider
- provider Lowell Blick
- Payer
- payer Medicaid
Record id
003b30a0-7fd2-f42c-0e74-373f025ed4a8