Claim total
$910.06
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1958-06-25
- Stop
- 1958-06-25
The parties
- Patient
- patient Kim Edmundo Rolfson
- Provider
- provider Tangela Koelpin
- Payer
- payer No insurance
Record id
03d7ab8f-b989-4d49-8ce3-f0c241a68347