Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-09-29
- Stop
- 2012-09-29
The parties
- Patient
- patient Gerardo Marvin Johns
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
01513b97-46a6-1303-9df9-ea58e95fce13