Claim total
$780.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1983-07-20
- Stop
- 1983-07-20
The parties
- Patient
- patient Jordan Darrel Hodkiewicz
- Provider
- provider Rodrick Moen
- Payer
- payer No insurance
Record id
26a1fd64-1e1f-4fc3-9136-159a3ef25361