Claim total
$1,132.05
base $93.83 · payer covered $905.64
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-04-17
- Stop
- 2017-04-17
The parties
- Patient
- patient Vella Divina Renner
- Provider
- provider Olin Mosciski
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer UnitedHealthcare
Record id
02404bb7-0f7d-3a30-be99-43292dc6d776