Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-02-11
- Stop
- 2006-02-11
The parties
- Patient
- patient Jamison Alvin Bergstrom
- Provider
- provider Venita Fahey
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer No insurance
Record id
33741f48-9c23-8cfc-01f3-5fa1b4f47ca6