Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2008-05-04
- Stop
- 2008-05-05
The parties
- Patient
- patient Heriberto Bennie Walsh
- Provider
- provider Joaquin Krajcik
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
02b5c001-4bdb-16d2-eb9a-b231bd4a739c