Claim total
$974.28
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1996-07-07
- Stop
- 1996-07-07
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-3b03-d49616db6e4a