Claim total
$775.00
base $93.83 · payer covered $675.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-09-22
- Stop
- 2016-09-22
The parties
- Patient
- patient Santa Antonina Bernier
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
051f1153-ae45-1425-e4dc-5f38d4b63111