Claim total
$773.83
base $93.83 · payer covered $773.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-08-05
- Stop
- 2018-08-05
The parties
- Patient
- patient Abdul Sammie Spencer
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
009b9fb1-8515-f33d-1d8c-44f90b8b7062