Claim total
$846.78
base $93.83 · payer covered $696.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1971-03-29
- Stop
- 1971-03-29
The parties
- Patient
- patient Chung Spinka
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
0453bbfc-4b53-3293-029e-8a69330c1411