Claim total
$641.13
base $93.83 · payer covered $591.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1984-04-24
- Stop
- 1984-04-24
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Hermine Stoltenberg
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0274bb53-c777-eb96-3281-3ec008cd9b8b