Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1974-06-07
- Stop
- 1974-06-07
The parties
- Patient
- patient Ronnie Ina Gusikowski
- Provider
- provider Jared Berge
- Payer
- payer Medicaid
Record id
003b30a0-7fd2-f42c-87a6-ce1b0a32e667