Claim total
$1,109.65
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1980-10-13
- Stop
- 1980-10-13
The parties
- Provider
- provider Alfred Moen
- Care site
- care site ADVANCED MEDICAL CENTER INC
- Payer
- payer No insurance
Record id
19dc752b-e77d-1085-8e1b-340b5da4baa0