Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-07-22
- Stop
- 2003-07-22
The parties
- Patient
- patient Tereasa Quigley
- Provider
- provider Jayme Rempel
- Care site
- care site LIFE LINE COMMUNITY HEALTHCARE
- Payer
- payer No insurance
Record id
1fa9953f-bec7-471e-9d3e-bb0e65d94863