Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-03-06
- Stop
- 2004-03-06
The parties
- Patient
- patient Jeremy Gregory Jacobson
- Provider
- provider Trent Kozey
Record id
04f9baea-0c64-12b2-3bb3-74fbcee8cc08