Claim total
$1,463.73
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-07-08
- Stop
- 2013-07-08
The parties
- Patient
- patient Chantay Victorina Koepp
- Provider
- provider Trent Kozey
- Payer
- payer No insurance
Record id
00c59201-9d52-fccb-1713-2c1f51829d36