Claim total
$780.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-06-14
- Stop
- 2022-06-14
The parties
- Patient
- patient Jammie Rippin
- Provider
- provider Lowell Blick
- Payer
- payer Aetna
Record id
2471679b-8c00-2fe1-8d13-907360b03257