Claim total
$505.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-12-03
- Stop
- 2016-12-03
The parties
- Patient
- patient Angele Khalilah Kuphal
- Provider
- provider Rodrick Moen
- Payer
- payer No insurance
Record id
044947be-396f-8eb7-d909-0629c1d6748c