Claim total
$1,046.06
base $93.83 · payer covered $946.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-07-15
- Stop
- 2020-07-15
The parties
- Provider
- provider Nicolas Raynor
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
010d736c-d81f-3cd7-e68c-fbb81a329f30