Claim total
$978.26
base $155.66 · payer covered $978.26
The visit
- Class
- Ambulatory
- Code
- 169762003
- Reason
- —
- Start
- 2025-08-18
- Stop
- 2025-08-18
The parties
- Patient
- patient Onie Shannon Borer
- Provider
- provider Daryl Farrell
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Aetna
Record id
006af299-d813-2b4f-817f-e1e6cc588621