Claim total
$930.40
base $93.83 · payer covered $780.40
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1986-12-03
- Stop
- 1986-12-03
The parties
- Patient
- patient Deirdre Shannon Hayes
- Provider
- provider Hiram Nitzsche
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0194ec83-bb8c-3a71-9e0a-fb74435cf201