Claim total
$1,517.57
base $93.83 · payer covered $1,517.57
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-10-28
- Stop
- 2012-10-28
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-f0bc-82530d3ef57c