Claim total
$910.06
base $93.83 · payer covered $760.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1983-09-13
- Stop
- 1983-09-13
The parties
- Patient
- patient Marcelo Roland Daniel
- Provider
- provider Alphonse Kozey
- Payer
- payer Medicaid
Record id
172af60a-c1b7-eaec-9255-dbed0f19f4c4