Claim total
$1,269.22
base $93.83 · payer covered $1,269.22
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-04-04
- Stop
- 2017-04-04
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-6323-5f36cabe8c20