Claim total
$711.28
base $93.39 · payer covered $561.28
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2016-07-12
- Stop
- 2016-07-12
The parties
- Patient
- patient Louella Roberts
- Provider
- provider Burton O'Conner
- Payer
- payer Medicaid
Record id
05092f50-4c35-2d72-fd63-6ef5946791db