Claim total
$704.41
base $93.83 · payer covered $604.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-07-22
- Stop
- 2026-07-22
The parties
- Provider
- provider Shonta Hayes
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
010d736c-d81f-3cd7-8d8f-773df75c7924