Claim total
$644.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1944-11-04
- Stop
- 1944-11-04
The parties
- Provider
- provider Elbert Schaefer
- Payer
- payer No insurance
Record id
14f87ac6-4d7d-9114-7289-6d2b13116f5d