Claim total
$704.41
base $93.83 · payer covered $554.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-03-03
- Stop
- 2002-03-03
The parties
- Patient
- patient Brandon Clint Pacocha
- Provider
- provider Jamie Hackett
- Payer
- payer Medicaid
Record id
2d097868-35ff-1c12-4efb-7f84e97b3e55