Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-01-19
- Stop
- 2019-01-19
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider George Rowe
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-7526-e4225c2f784b