Claim total
$780.15
base $93.83 · payer covered $780.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1955-08-19
- Stop
- 1955-08-19
The parties
- Patient
- patient Raye Suzy Gusikowski
- Provider
- provider Hank Orn
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Humana
Record id
02c06e54-48b8-2b73-c9eb-1d46d73bc477