Claim total
$1,496.69
base $93.83 · payer covered $1,496.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-03-22
- Stop
- 2014-03-22
The parties
- Patient
- patient Jeremy Gregory Jacobson
- Provider
- provider Trent Kozey
Record id
04f9baea-0c64-12b2-54d4-cc51ac960f1d