Claim total
$973.34
base $93.83 · payer covered $873.34
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-10-14
- Stop
- 2025-10-14
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-fcc3-b564129be8c5