Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-02-01
- Stop
- 2020-02-01
The parties
- Patient
- patient Clarine Nana Kiehn
- Provider
- provider Clair White
- Care site
- care site DUE NORTH WELLNESS CENTER PLLC
- Payer
- payer Medicaid
Record id
05754ab1-1584-1eea-74c2-53acbca2c68e