Claim total
$767.69
base $93.83 · payer covered $667.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-07-03
- Stop
- 2014-07-03
The parties
- Patient
- patient Johnny Mattie Skiles
- Provider
- provider Jamison Rau
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
01f72a06-0d81-377c-7e4b-ef5872fc25a0