Claim total
$1,298.30
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-11-23
- Stop
- 2007-11-23
The parties
- Patient
- patient Emma Daphne Gusikowski
- Provider
- provider Tangela Koelpin
Record id
135051de-1be9-22ef-ba83-b5ac74693193