Claim total
$899.40
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1995-05-28
- Stop
- 1995-05-28
The parties
- Patient
- patient Roy Russ Bergstrom
- Provider
- provider Luisa Wilkinson
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer No insurance
Record id
13201b82-c84d-0844-93c6-b38d99970a95