Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-03-21
- Stop
- 2011-03-21
The parties
- Patient
- patient Rosaria Golden Bashirian
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
015dd051-d88b-0f3d-a01b-179cb440b406