Claim total
$1,722.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1994-04-30
- Stop
- 1994-04-30
The parties
- Patient
- patient Tomas Josh Larson
- Provider
- provider Marlon Glover
- Payer
- payer No insurance
Record id
2f6a8fd0-a41d-4cac-2865-eeab956eeef6