Claim total
$773.83
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-05-09
- Stop
- 2019-05-09
The parties
- Patient
- patient Kaycee Luanne Mohr
- Provider
- provider Venita Fahey
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer No insurance
Record id
03ac889d-2da8-a492-f520-031b633de61f