Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1977-09-26
- Stop
- 1977-09-26
The parties
- Patient
- patient Maria Dibbert
- Provider
- provider Mose Nicolas
- Payer
- payer No insurance
Record id
000287f5-a0d8-f77b-7a80-6577478dba41