Claim total
$505.13
base $93.83 · payer covered $405.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-04-16
- Stop
- 2012-04-17
The parties
- Patient
- patient Elliott Crooks
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
016f6acf-14e3-04d0-ff5c-7954ac0f5b50