Claim total
$1,115.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1996-04-03
- Stop
- 1996-04-03
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Julene Lemke
- Payer
- payer No insurance
Record id
00e3929f-91f8-0715-ad90-8fa965b156ef