Claim total
$229.83
base $93.83 · payer covered $129.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2021-01-04
- Stop
- 2021-01-04
The parties
- Patient
- patient Coretta Philomena Boyle
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
06293262-0c72-c029-0b5c-d08bd31f415e