Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-03-18
- Stop
- 2019-03-18
The parties
- Patient
- patient Leif Darren West
- Provider
- provider Rodrick Moen
- Payer
- payer Humana
Record id
04bc601b-5b17-3710-210e-c5d69185b7b2