Claim total
$1,112.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-07-14
- Stop
- 2019-07-14
The parties
- Patient
- patient Leo Ramon Wolf
- Provider
- provider Jared Berge
- Payer
- payer Aetna
Record id
0132d8d5-6e6e-d90f-885e-892d3a131024