Claim total
$772.84
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-04-03
- Stop
- 1997-04-03
The parties
- Patient
- patient Hilario Thad Orn
- Provider
- provider Venita Fahey
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer No insurance
Record id
27964ba9-ad2a-94be-e42e-2bf4997accff