Claim total
$1,212.48
base $93.83 · payer covered $1,062.48
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1998-03-10
- Stop
- 1998-03-10
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-72ba-9d3bdd7417cc