Claim total
$1,115.43
base $93.83 · payer covered $1,065.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-04-09
- Stop
- 2002-04-09
The parties
- Provider
- provider Hank Orn
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
34548186-03af-72a7-6440-1f96ffd819ae