Claim total
$1,463.73
base $93.83 · payer covered $1,363.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-04-11
- Stop
- 2011-04-12
The parties
- Patient
- patient Elliott Crooks
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
016f6acf-14e3-04d0-965b-3b54bcefbdeb