Claim total
$767.69
base $93.83 · payer covered $767.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-01-26
- Stop
- 2019-01-26
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-ea85-e93d1c86df3f