Claim total
$846.78
base $93.83 · payer covered $696.78
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1976-06-18
- Stop
- 1976-06-18
The parties
- Patient
- patient Ronnie Ina Gusikowski
- Provider
- provider Julene Lemke
- Payer
- payer Medicaid
Record id
003b30a0-7fd2-f42c-5562-6e9bcf055d08