Claim total
$641.13
base $93.83 · payer covered $606.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1953-04-28
- Stop
- 1953-04-28
The parties
- Provider
- provider Magen Mertz
- Payer
- payer Dual Eligible
Record id
0126321a-a5af-784d-5143-7eabf3eb1096