Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2004-09-22
- Stop
- 2004-09-22
The parties
- Patient
- patient Sha Robin Reilly
- Provider
- provider Hank Orn
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
043d6e13-0cc7-07f3-396e-91f9c1f8e40a