Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-02-11
- Stop
- 2023-02-11
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Kenneth Mayert
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-9ac6-cd76c3b6f14d