Claim total
$906.71
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-09-13
- Stop
- 2004-09-13
The parties
- Patient
- patient Leif Darren West
- Provider
- provider Elbert Schaefer
- Payer
- payer No insurance
Record id
04bc601b-5b17-3710-f567-5bb7bde624cd