Claim total
$846.78
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1972-02-17
- Stop
- 1972-02-17
The parties
- Patient
- patient Donn Jason Stanton
- Provider
- provider Magen Mertz
- Payer
- payer No insurance
Record id
1865a78e-26da-9b77-24eb-893bd6579991