Claim total
$775.00
base $93.83 · payer covered $433.59
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-12-02
- Stop
- 2024-12-02
The parties
- Patient
- patient Alyson Janie Marquardt
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicare
Record id
00faac37-85e6-9663-8f26-60f78f837e4e