Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1971-10-15
- Stop
- 1971-10-15
The parties
- Patient
- patient Reyna Carroll
- Provider
- provider Garry Vandervort
- Care site
- care site LIFE LINE COMMUNITY HEALTHCARE
- Payer
- payer No insurance
Record id
12cb4f8d-eea3-ec6a-ff9f-4b0a1f7d53a9