Claim total
$767.69
base $93.83 · payer covered $667.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-01-12
- Stop
- 2006-01-12
The parties
- Patient
- patient Latonya Marisa Welch
- Provider
- provider Tangela Koelpin
- Payer
- payer Medicaid
Record id
3316b1fd-ee41-7777-02dc-1e5d1080d4e1