Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-07-14
- Stop
- 2014-07-14
The parties
- Patient
- patient Chantay Victorina Koepp
- Provider
- provider Randee Sawayn
- Payer
- payer No insurance
Record id
00c59201-9d52-fccb-9633-f12b97955a93