Claim total
$1,285.50
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1951-12-20
- Stop
- 1951-12-20
The parties
- Patient
- patient Nicole Kelsi Sipes
- Provider
- provider Magen Mertz
- Payer
- payer No insurance
Record id
0cb983be-15db-fabe-e0ba-da467c6c4d32