Claim total
$976.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1996-09-20
- Stop
- 1996-09-20
The parties
- Patient
- patient Emma Daphne Gusikowski
- Provider
- provider Elbert Schaefer
- Payer
- payer No insurance
Record id
135051de-1be9-22ef-61ae-daa1f041649d