Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1996-06-12
- Stop
- 1996-06-12
The parties
- Patient
- patient Kevin Ivory Dooley
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
289919b6-33cc-df6a-f100-e5ffbb40a443