Claim total
$1,185.08
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1989-09-29
- Stop
- 1989-09-29
The parties
- Patient
- patient Jerrell Antwan Powlowski
- Provider
- provider Fidel Dach
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer No insurance
Record id
3b2d7c05-6e2b-4868-f448-71a65bf7722d