Claim total
$978.26
base $155.66 · payer covered $928.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2018-10-18
- Stop
- 2018-10-18
The parties
- Patient
- patient Johnny Mattie Skiles
- Provider
- provider Burton O'Conner
- Payer
- payer Medicaid
Record id
01f72a06-0d81-377c-175f-ce90f2b96428