Claim total
$1,071.12
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1980-04-24
- Stop
- 1980-04-24
The parties
- Patient
- patient Yvonne Ondricka
- Provider
- provider Elbert Schaefer
- Payer
- payer No insurance
Record id
2651fa10-73ce-522f-7663-aeba50c9b3bd