Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-03-01
- Stop
- 2004-03-01
The parties
- Patient
- patient Shaneka Katheleen Grady
- Provider
- provider Trent Kozey
- Payer
- payer No insurance
Record id
302f7405-9f23-5548-f80b-6a9c8fe1d70a