Claim total
$840.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-07-27
- Stop
- 2026-07-27
The parties
- Patient
- patient Chantay Victorina Koepp
- Provider
- provider Trent Kozey
- Payer
- payer No insurance
Record id
00c59201-9d52-fccb-a86c-58050031cf81