Claim total
$978.26
base $155.66 · payer covered $928.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2021-05-25
- Stop
- 2021-05-25
The parties
- Patient
- patient Mirta Nakisha Franecki
- Provider
- provider Dale Mertz
- Payer
- payer Medicaid
Record id
05902870-85f1-fda1-2541-06e978c7b9c9