Claim total
$1,163.79
base $93.83 · payer covered $1,063.79
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2021-01-30
- Stop
- 2021-01-30
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider George Rowe
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-5296-8ab87fd08517