Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-07-02
- Stop
- 2012-07-02
The parties
- Patient
- patient Adam Jones
- Provider
- provider Richard Carter
- Care site
- care site SAMA HEALTH CARE
- Payer
- payer Aetna
Record id
00229130-e769-8779-05bd-7744d29e3985