Claim total
$906.71
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1999-03-02
- Stop
- 1999-03-02
The parties
- Patient
- patient Milford Alfonso Thiel
- Provider
- provider Tangela Koelpin
- Payer
- payer No insurance
Record id
1f816600-b043-d586-e2e1-9c86c5d071d9