Claim total
$846.78
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-12-09
- Stop
- 2017-12-09
The parties
- Patient
- patient Angele Khalilah Kuphal
- Provider
- provider Tangela Koelpin
- Payer
- payer No insurance
Record id
044947be-396f-8eb7-f9bd-9a55c66a90ad