Claim total
$711.72
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-02-17
- Stop
- 2014-02-17
The parties
- Patient
- patient Leif Darren West
- Provider
- provider Tangela Koelpin
- Payer
- payer Humana
Record id
04bc601b-5b17-3710-7908-0d7a3a766569