Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-12-16
- Stop
- 2025-12-16
The parties
- Patient
- patient Jared Lenard Hansen
- Provider
- provider Ronnie Gleason
- Payer
- payer Aetna
Record id
047ee4ec-c50b-b504-469b-3ea1e8c57ef7