Claim total
$1,290.81
base $93.83 · payer covered $1,190.81
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-03-19
- Stop
- 2019-03-19
The parties
- Patient
- patient An Wenona Rau
- Provider
- provider Julene Lemke
- Payer
- payer Medicaid
Record id
04682680-f77d-0a00-fa2b-65d8f866e464