Claim total
$631.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-10-13
- Stop
- 2011-10-13
The parties
- Provider
- provider Ursula Nolan
- Payer
- payer No insurance
Record id
0366d403-b006-0b76-0bb6-29e244c5095a