Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-03-12
- Stop
- 1991-03-12
The parties
- Patient
- patient Chia Jalisa Champlin
- Provider
- provider Nestor Kling
- Payer
- payer No insurance
Record id
03f9d33d-12ca-f1a8-6f88-157e4bcb0ca7