Claim total
$775.00
base $93.83 · payer covered $775.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-02-01
- Stop
- 2013-02-01
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-c341-49802044371e