Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1980-11-21
- Stop
- 1980-11-21
The parties
- Patient
- patient Alphonse Ricky Bernhard
- Provider
- provider Criselda Bartell
- Payer
- payer No insurance
Record id
2e3c3108-70f2-7f33-dfec-66bf3a878fc2