Claim total
$1,219.43
base $93.83 · payer covered $1,119.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-04-04
- Stop
- 2018-04-04
The parties
- Patient
- patient Kevin Ivory Dooley
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
289919b6-33cc-df6a-a4ab-aa5ccf3fc16c