Claim total
$840.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-06-17
- Stop
- 2025-06-17
The parties
- Patient
- patient Sherill Ingeborg Wyman
- Provider
- provider Rodrick Moen
- Payer
- payer No insurance
Record id
03eccc4c-a1c4-14ad-bed5-b8dc09a7f398