Claim total
$787.46
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1981-11-29
- Stop
- 1981-11-29
The parties
- Patient
- patient Kirk Ty Jacobs
- Provider
- provider Adelia Dickens
- Care site
- care site WELLNESS CENTERS, PLLC
- Payer
- payer No insurance
Record id
1e3196f8-1036-fdb0-3ce0-adfa95f45971