Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2012-11-24
- Stop
- 2012-11-24
The parties
- Patient
- patient Arlene Maurine Dibbert
- Provider
- provider Trisha Gleason
- Payer
- payer Medicaid
Record id
147bb29a-9ad7-3264-4a08-c42d2f4f97ee