Claim total
$982.78
base $93.83 · payer covered $832.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-01-02
- Stop
- 2005-01-02
The parties
- Patient
- patient Adrian Grady O'Keefe
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
00a9bdc8-6b4d-5df7-ff52-ef369af53280