Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-07-27
- Stop
- 2005-07-27
The parties
- Patient
- patient Kim Edmundo Rolfson
- Provider
- provider Tangela Koelpin
- Payer
- payer No insurance
Record id
03d7ab8f-b989-4d49-fc4f-88503ed867f0