Claim total
$6,081.83
base $93.83 · payer covered $6,046.83
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1978-10-25
- Stop
- 1978-10-25
The parties
- Patient
- patient Jody Antoine Metz
- Provider
- provider Jack Grimes
- Care site
- care site ADVANCED MEDICAL CENTER INC
- Payer
- payer Dual Eligible
Record id
072c7291-f02c-909b-9c50-a0c17b22c071