Claim total
$1,072.12
base $93.83 · payer covered $972.12
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2024-12-15
- Stop
- 2024-12-15
The parties
- Patient
- patient Margo Green
- Provider
- provider Pearly Rohan
- Payer
- payer Medicaid
Record id
029fe5e1-f60c-f237-8a60-84b06c07829c