Claim total
$985.36
base $93.39 · payer covered $878.75
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2011-10-25
- Stop
- 2011-10-25
The parties
- Patient
- patient Brock Hershel Terry
- Provider
- provider Pasquale Grimes
- Payer
- payer Medicaid
Record id
0d1ab67c-633f-1c52-bd1b-76a6664e1564