Claim total
$641.13
base $93.83 · payer covered $327.98
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-09-23
- Stop
- 2015-09-23
The parties
- Patient
- patient Kim Edmundo Rolfson
- Provider
- provider Tangela Koelpin
- Payer
- payer Medicare
Record id
03d7ab8f-b989-4d49-939c-d935eb8e63df