Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-05-11
- Stop
- 2015-05-11
The parties
- Patient
- patient Matha Wanetta Greenholt
- Provider
- provider Jared Berge
- Payer
- payer Aetna
Record id
38475c93-5cdf-8ed5-76ad-c6dd757cf652