Claim total
$840.41
base $93.83 · payer covered $840.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-12-13
- Stop
- 2025-12-13
The parties
- Patient
- patient Gerardo Marvin Johns
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
01513b97-46a6-1303-a0fa-583a39036a5f