Claim total
$1,291.11
base $93.83 · payer covered $1,141.11
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1998-02-13
- Stop
- 1998-02-13
The parties
- Patient
- patient Lelia Ariana Metz
- Provider
- provider Miles Kuphal
- Care site
- care site WELLNESS CENTERS, PLLC
- Payer
- payer Medicaid
Record id
28793fbe-ecef-a924-b077-506ee0165413