Claim total
$1,194.52
base $93.83 · payer covered $1,044.52
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1989-04-22
- Stop
- 1989-04-22
The parties
- Patient
- patient Mariana Ana Ornelas
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
11444f3f-edac-88ba-bf20-d21655da80c9