Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-10-01
- Stop
- 2009-10-01
The parties
- Provider
- provider Elbert Schaefer
- Payer
- payer No insurance
Record id
0366d403-b006-0b76-56f8-520db6514316