Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-08-11
- Stop
- 2003-08-11
The parties
- Patient
- patient Latrisha Simonne Kuhlman
- Provider
- provider Anneliese Bradtke
- Payer
- payer No insurance
Record id
0277738c-b3e3-4ada-7bda-44cb2cad97d5