Claim total
$1,389.16
base $93.83 · payer covered $1,389.16
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-03-29
- Stop
- 2021-03-29
The parties
- Patient
- patient Leif Darren West
- Provider
- provider Tangela Koelpin
- Payer
- payer Humana
Record id
04bc601b-5b17-3710-cce1-81cdb25beb9b