- Claim
- 25017374
- Patient
- Carl, Jason
- Payor
- Aetna
- Claim Date
- 14/02/2017
- Case #
- 25017374
- Payment
- $267.76
- Check #
- 128007158
- Status
- Pending
- BALANCE FORWARD
Revenue Lines for Above Selected Claim
Service Date |
Service Description |
Procedure Code |
Procedure Description |
Amount |
Payment |
Balance |
Balance Transfer |
|---|---|---|---|---|---|---|---|
| 14/02/2017 | Group Therapy - Rehabilitation | 90820 | Psychotheraphy 30 Minutes | $375.00 |