Claim total
$702.28
base $93.83 · payer covered $561.81
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-10-06
- Stop
- 2014-10-06
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-cf13-1c2ee4dc2980