Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1979-06-11
- Stop
- 1979-06-11
The parties
- Patient
- patient Kelvin Johnny Hirthe
- Provider
- provider Shani Carroll
- Payer
- payer No insurance
Record id
292b5aae-02fc-4e2f-23f2-c846f5f1d7e6