Claim total
$1,043.93
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-04-03
- Stop
- 2009-04-03
The parties
- Patient
- patient Claudia Clara Varela
- Provider
- provider Tangela Koelpin
- Payer
- payer Aetna
Record id
2011d4e0-6256-2305-dfe9-a172fb210c57