Claim total
$1,251.43
base $93.83 · payer covered $55.98
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-05-24
- Stop
- 2025-05-24
The parties
- Patient
- patient Phillip Donovan Beahan
- Provider
- provider Garret Mohr
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Anthem
Record id
248f8008-89fe-dc1a-1740-c0475d783a79