Claim total
$1,420.98
base $93.83 · payer covered $1,420.98
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-10-09
- Stop
- 2011-10-09
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Garret Mohr
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-91d8-af26bcd33637