Claim total
$910.06
base $93.83 · payer covered $810.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-12-09
- Stop
- 2020-12-09
The parties
- Patient
- patient Deirdre Shannon Hayes
- Provider
- provider Hiram Nitzsche
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0194ec83-bb8c-3a71-40d1-86bfb96ea61c