Claim total
$780.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1978-09-28
- Stop
- 1978-09-28
The parties
- Patient
- patient Dylan Mante
- Provider
- provider Pearly Rohan
- Payer
- payer No insurance
Record id
1d345bd8-58e2-79a2-65fd-0a88b1b0c5cc