Claim total
$1,169.92
base $93.83 · payer covered $1,069.92
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-09-22
- Stop
- 2009-09-22
The parties
- Patient
- patient Annamarie Mollie Hoppe
- Provider
- provider Mitzie Kuhic
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
0555f11c-c453-57eb-3568-c07af18a700a