Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-12-18
- Stop
- 2004-12-18
The parties
- Patient
- patient Clarine Nana Kiehn
- Provider
- provider Cristina Schmitt
- Care site
- care site DUE NORTH WELLNESS CENTER PLLC
- Payer
- payer Medicaid
Record id
05754ab1-1584-1eea-9ee0-ac755cbae8a3