Claim total
$1,110.28
base $93.83 · payer covered $181.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-03-12
- Stop
- 2016-03-12
The parties
- Patient
- patient Brenna Myrtie VonRueden
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Anthem
Record id
248c77f0-90ce-d659-64da-902cc75419e7