Claim total
$772.84
base $93.83 · payer covered $772.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-12-21
- Stop
- 2017-12-21
The parties
- Patient
- patient Porfirio Edwin Haley
- Provider
- provider Tennille Baumbach
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Aetna
Record id
2e744073-c2bf-43ce-f0a3-7f33c79a9504