Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1960-07-06
- Stop
- 1960-07-06
The parties
- Patient
- patient Kim Edmundo Rolfson
- Provider
- provider Ursula Nolan
- Payer
- payer No insurance
Record id
03d7ab8f-b989-4d49-1420-75977429c09f