Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1990-07-02
- Stop
- 1990-07-02
The parties
- Patient
- patient Adrian Isaiah Durgan
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
046903bc-0773-63cf-d071-a92f6a382fe0