Claim total
$840.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-05-16
- Stop
- 2003-05-16
The parties
- Patient
- patient Gus Krajcik
- Provider
- provider Venita Fahey
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer No insurance
Record id
295755aa-ec3c-f3a6-c4ad-7efdc2f8bde0