Claim total
$969.99
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-01-14
- Stop
- 2011-01-14
The parties
- Patient
- patient Blair Myles Quigley
- Provider
- provider Jared Berge
- Payer
- payer No insurance
Record id
0eb5aff4-0c2a-6c13-729f-6bfff79f2a01