Claim total
$899.40
base $93.83 · payer covered $749.40
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-07-24
- Stop
- 2004-07-24
The parties
- Patient
- patient Cara Twana Rohan
- Provider
- provider Tangela Koelpin
- Payer
- payer Medicaid
Record id
36e78c82-a2fb-ce3c-c48a-4be1dfa198c2