Claim total
$1,517.90
base $93.83 · payer covered $1,417.90
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-04-22
- Stop
- 2015-04-22
The parties
- Patient
- patient Takako Harriett Toy
- Provider
- provider Mitzie Kuhic
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
19003a8c-29a0-fc7b-956e-347ee6cf349e