Claim total
$1,026.11
base $93.83 · payer covered $1,026.11
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-10-12
- Stop
- 2020-10-12
The parties
- Patient
- patient Adrian Isaiah Durgan
- Provider
- provider Trent Kozey
- Payer
- payer Dual Eligible
Record id
046903bc-0773-63cf-5025-436f278be134