Claim total
$1,229.97
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-02-11
- Stop
- 2013-02-11
The parties
- Patient
- patient Ike Branden Moore
- Provider
- provider Jared Berge
- Payer
- payer Aetna
Record id
2d876bca-be8f-2e05-d9db-8afd4b5366b3