Claim total
$772.84
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1992-05-22
- Stop
- 1992-05-22
The parties
- Patient
- patient Garry Kenton Vandervort
- Provider
- provider Sherwood Nicolas
- Payer
- payer No insurance
Record id
105a5425-4355-e889-c1b5-d026d6efb847