Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-06-18
- Stop
- 2004-06-18
The parties
- Provider
- provider Danica Stracke
- Care site
- care site CROWN MEDICAL CENTER
- Payer
- payer No insurance
Record id
02e77898-0a14-d00d-6cc9-8f78870cd52e