Claim total
$911.00
base $93.83 · payer covered $811.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-08-30
- Stop
- 2026-08-30
The parties
- Patient
- patient Adrian Grady O'Keefe
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
00a9bdc8-6b4d-5df7-e95c-0fbfb5be22d8