Claim total
$1,046.06
base $93.83 · payer covered $1,046.06
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-10-11
- Stop
- 2017-10-11
The parties
- Patient
- patient Cecilia Botsford
- Provider
- provider Hank Orn
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
046c8377-6cc1-c8f9-e823-8c576af0558e