Claim total
$846.78
base $93.83 · payer covered $846.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-11-28
- Stop
- 2017-11-28
The parties
- Patient
- patient Queen Sharika Fay
- Provider
- provider Norris Kertzmann
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
02c148c0-182c-a5fd-a95c-ae8781895eee