Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1969-12-18
- Stop
- 1969-12-18
The parties
- Patient
- patient Joan Donnie Quitzon
- Provider
- provider Magen Mertz
- Payer
- payer No insurance
Record id
056f2732-3438-a432-a36d-d081e31381b3