Claim total
$704.41
base $93.83 · payer covered $604.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-12-28
- Stop
- 2013-12-28
The parties
- Patient
- patient Clarine Nana Kiehn
- Provider
- provider Clair White
- Care site
- care site DUE NORTH WELLNESS CENTER PLLC
- Payer
- payer Medicaid
Record id
05754ab1-1584-1eea-4037-d5321ebba801