Claim total
$1,606.09
base $93.83 · payer covered $1,506.09
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-08-14
- Stop
- 2007-08-14
The parties
- Patient
- patient Sherill Ingeborg Wyman
- Provider
- provider Tangela Koelpin
- Payer
- payer Medicaid
Record id
03eccc4c-a1c4-14ad-a4ea-1022b3b43df4