Claim total
$777.13
base $93.83 · payer covered $777.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-03-12
- Stop
- 2025-03-12
The parties
- Patient
- patient Amanda Rheba Mitchell
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
0363ed75-83f4-7675-f6bd-56fec71aca52