Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1984-12-02
- Stop
- 1984-12-02
The parties
- Patient
- patient Kirk Ty Jacobs
- Provider
- provider Dan Leuschke
- Care site
- care site WELLNESS CENTERS, PLLC
- Payer
- payer No insurance
Record id
1e3196f8-1036-fdb0-3c56-7204f71592ae