Claim total
$843.43
base $93.83 · payer covered $743.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-09-24
- Stop
- 2020-09-24
The parties
- Patient
- patient Lacy Kattie Cartwright
- Provider
- provider Tangela Koelpin
- Payer
- payer Medicaid
Record id
10a5a577-972b-49ae-4485-7b513dc50c6d