Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1974-06-28
- Stop
- 1974-06-28
The parties
- Patient
- patient Raye Suzy Gusikowski
- Provider
- provider Mitzie Kuhic
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Humana
Record id
02c06e54-48b8-2b73-e185-93257f2170ae