Claim total
$956.24
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-10-18
- Stop
- 2012-10-18
The parties
- Provider
- provider Tangela Koelpin
- Payer
- payer No insurance
Record id
0366d403-b006-0b76-2643-bf41fbd4e8c5