Claim total
$711.72
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-02-11
- Stop
- 2026-02-11
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Lowell Blick
- Payer
- payer No insurance
Record id
00e3929f-91f8-0715-4ed9-295a9b0bc3e5