Claim total
$1,305.75
base $93.83 · payer covered $1,255.75
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1949-11-16
- Stop
- 1949-11-16
The parties
- Patient
- patient Perla Roseanne Herzog
- Provider
- provider Tangela Koelpin
- Payer
- payer Medicaid
Record id
1e76911d-0c60-0943-2d12-d97586b764df