Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-11-05
- Stop
- 2021-11-05
The parties
- Patient
- patient Marilynn Jaimie Pouros
- Provider
- provider Tangela Koelpin
- Payer
- payer Humana
Record id
0126af27-a469-d3f6-606c-3a113ba9bbe9