Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1992-03-25
- Stop
- 1992-03-25
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Jared Berge
- Payer
- payer No insurance
Record id
00e3929f-91f8-0715-9241-279c378ae496