Claim total
$780.15
base $93.83 · payer covered $780.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-03-22
- Stop
- 2023-03-23
The parties
- Patient
- patient Rodolfo Cesar Cartwright
- Provider
- provider Tangela Koelpin
- Payer
- payer Dual Eligible
Record id
1c95d9b2-6189-e9d5-7c46-f165fca65734