Claim total
$846.78
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2014-06-29
- Stop
- 2014-06-29
The parties
- Patient
- patient Leo Ramon Wolf
- Provider
- provider Jared Berge
- Payer
- payer Anthem
Record id
0132d8d5-6e6e-d90f-d037-45e80159ee8a