Claim total
$846.78
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-10-07
- Stop
- 2017-10-07
The parties
- Patient
- patient Marylou Luci Blanda
- Provider
- provider Anneliese Bradtke
- Payer
- payer No insurance
Record id
1e1c2fac-caa8-1b64-568d-a0860004253d