Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-11-22
- Stop
- 2005-11-22
The parties
- Patient
- patient Lavelle Rufina Conn
- Provider
- provider Brenda Moore
- Payer
- payer No insurance
Record id
18ade4c0-e8ba-7cd6-14ca-4818b8c26a6f