Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-05-26
- Stop
- 1991-05-27
The parties
- Patient
- patient Mike Brendon Hackett
- Provider
- provider Rodrick Moen
- Payer
- payer No insurance
Record id
048bde62-95d9-bb18-0976-194c25bea763