Claim total
$3,903.02
base $93.83 · payer covered $3,753.02
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1965-08-25
- Stop
- 1965-08-25
The parties
- Patient
- patient Jody Antoine Metz
- Provider
- provider Jack Grimes
- Care site
- care site ADVANCED MEDICAL CENTER INC
- Payer
- payer Medicaid
Record id
072c7291-f02c-909b-18f3-bfb7b05efbc4