Claim total
$1,112.41
base $93.83 · payer covered $165.99
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-04-06
- Stop
- 2015-04-06
The parties
- Patient
- patient Vella Divina Renner
- Provider
- provider Samantha Schmidt
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer UnitedHealthcare
Record id
02404bb7-0f7d-3a30-cacd-f77960bd86f8