Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1972-08-24
- Stop
- 1972-08-24
The parties
- Patient
- patient Dylan Mante
- Provider
- provider Pearly Rohan
- Payer
- payer No insurance
Record id
1d345bd8-58e2-79a2-1bc2-6d84071cbe32