Claim total
$1,251.43
base $93.83 · payer covered $1,251.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-07-09
- Stop
- 2012-07-09
The parties
- Patient
- patient Angel Reginald Barrows
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Dual Eligible
Record id
1dedb48b-0b8d-047b-aa5b-c5c7003033c6