Claim total
$1,238.75
base $93.83 · payer covered $814.36
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-05-23
- Stop
- 2022-05-23
The parties
- Patient
- patient Chung Spinka
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicare
Record id
0453bbfc-4b53-3293-e574-61032d76f7f0