Claim total
$293.11
base $93.83 · payer covered $243.11
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1968-05-03
- Stop
- 1968-05-03
The parties
- Patient
- patient Ronnie Ina Gusikowski
- Provider
- provider Julene Lemke
- Payer
- payer Medicaid
Record id
003b30a0-7fd2-f42c-7b66-36966d74fff8