Claim total
$903.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-09-05
- Stop
- 2012-09-05
The parties
- Patient
- patient Tim Taylor Terry
- Provider
- provider Andria Spinka
- Payer
- payer Humana
Record id
03607fcd-7c51-41c0-3741-402226fdbe7f