Claim total
$1,058.72
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-02-18
- Stop
- 2009-02-18
The parties
- Patient
- patient Vince Kelley Grimes
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
Record id
28d8b15e-8b0d-2cef-8579-0d9528cca23b