Claim total
$700.12
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1942-05-06
- Stop
- 1942-05-06
The parties
- Patient
- patient Owen Moen
- Provider
- provider Elna Johnston
- Payer
- payer No insurance
Record id
2f17d29a-ecaf-d52e-1535-ca8372a447ae