Claim total
$1,251.71
base $93.83 · payer covered $1,001.36
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-12-28
- Stop
- 2019-12-28
The parties
- Patient
- patient Gonzalo Goodwin
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicare
Record id
1b095863-7386-17e5-60c8-78608864ad37