Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-01-16
- Stop
- 2025-01-16
The parties
- Patient
- patient Kaycee Luanne Mohr
- Provider
- provider Venita Fahey
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer No insurance
Record id
03ac889d-2da8-a492-ec68-59a91e6c321a