Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-04-20
- Stop
- 2011-04-20
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Lowell Blick
- Payer
- payer No insurance
Record id
00e3929f-91f8-0715-1e0b-bb4f0f37149e