Claim total
$911.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-09-26
- Stop
- 2003-09-26
The parties
- Patient
- patient Loma Tawanna Ferry
- Provider
- provider Anneliese Bradtke
- Payer
- payer No insurance
Record id
04384da7-7311-e99a-4f39-973bd687881d