Claim total
$1,251.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-02-05
- Stop
- 2015-02-05
The parties
- Patient
- patient Jonathan Coleman Legros
- Provider
- provider Venita Fahey
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer No insurance
Record id
2ed452da-dcac-b9bd-58fc-59dfe7b81f8f