Claim total
$1,112.36
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1996-03-06
- Stop
- 1996-03-06
The parties
- Patient
- patient Darby Deane Graham
- Provider
- provider Jan Nicolas
- Payer
- payer No insurance
Record id
38225557-920e-dbf8-b316-c628cafd7a5c