Claim total
$1,375.33
base $93.83 · payer covered $1,325.33
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2004-06-02
- Stop
- 2004-06-02
The parties
- Provider
- provider Gwenn Hermann
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
010d736c-d81f-3cd7-33a5-07e70a6d1204