Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1953-05-09
- Stop
- 1953-05-09
The parties
- Patient
- patient Elbert Jamar Grant
- Provider
- provider Billie Abbott
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer No insurance
Record id
1f492d1b-46b8-92c2-87cf-72192b173310