Claim total
$972.12
base $93.83 · payer covered $822.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-01-07
- Stop
- 1997-01-07
The parties
- Patient
- patient Loren Marquardt
- Provider
- provider Miles Kuphal
- Care site
- care site WELLNESS CENTERS, PLLC
- Payer
- payer Medicaid
Record id
39dcad59-6ff7-b3bb-ab1b-c4f61170a093