Claim total
$694.97
base $93.83 · payer covered $694.97
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-11-03
- Stop
- 2013-11-03
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-d7b8-ed08cd79b9da