Claim total
$1,209.22
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-07-10
- Stop
- 2016-07-10
The parties
- Patient
- patient Leo Ramon Wolf
- Provider
- provider Julene Lemke
- Payer
- payer Aetna
Record id
0132d8d5-6e6e-d90f-c01a-60929b80273d