Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-02-15
- Stop
- 2018-02-15
The parties
- Patient
- patient Donita Kasandra Crooks
- Provider
- provider Tanna Macejkovic
- Payer
- payer Humana
Record id
277f7208-da9a-7c08-c6f8-70fe9aa5e7ec