Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1973-04-11
- Stop
- 1973-04-11
The parties
- Patient
- patient Shon Cesar Ebert
- Provider
- provider Magen Mertz
- Payer
- payer No insurance
Record id
03d8f92f-53db-d7af-8f99-33ce19d557ab