Claim total
$1,112.41
base $93.83 · payer covered $1,012.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-02-14
- Stop
- 2026-02-14
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider George Rowe
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-8c08-6da14d464ed2