Claim total
$1,187.56
base $93.83 · payer covered $1,187.56
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-04-11
- Stop
- 2025-04-11
The parties
- Patient
- patient Wilson Teodoro Kihn
- Provider
- provider Hank Orn
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
04540647-5ff4-de4a-be79-aa98b764e433