Claim total
$1,463.73
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1986-06-28
- Stop
- 1986-06-28
The parties
- Patient
- patient Berta Cruz
- Provider
- provider José Emilio Saucedo
- Care site
- care site SOUTHDALE INTERNAL MEDICINE PA
- Payer
- payer No insurance
Record id
113b9e50-1286-0e01-b2ba-af776ce41a6c