Claim total
$910.06
base $93.83 · payer covered $544.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-04-11
- Stop
- 2017-04-11
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Lola Fadel
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicare
Record id
0274bb53-c777-eb96-6a6e-ffff6485190f