Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1987-08-17
- Stop
- 1987-08-17
The parties
- Patient
- patient Leif Darren West
- Provider
- provider Ursula Nolan
- Payer
- payer No insurance
Record id
04bc601b-5b17-3710-439e-3288219f65b7