Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-08-03
- Stop
- 2012-08-03
The parties
- Patient
- patient Colby Wunsch
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
02d10ce5-acf0-36ed-a5f1-f7bac8f4bb30