Claim total
$1,105.05
base $93.83 · payer covered $955.05
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1980-07-20
- Stop
- 1980-07-20
The parties
- Patient
- patient Solomon Amado Purdy
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
1e6fa6a9-1f41-5355-3cea-b3988b09e111