Claim total
$777.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-04-20
- Stop
- 2024-04-20
The parties
- Patient
- patient Zachery Vincenzo Berge
- Provider
- provider Ursula Nolan
- Payer
- payer Aetna
Record id
01ce818c-8f9f-924a-3038-8f596790495a