Claim total
$775.00
base $93.83 · payer covered $625.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1983-12-10
- Stop
- 1983-12-10
The parties
- Patient
- patient Elbert Rod Lemke
- Provider
- provider Maryam Wolf
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
039e51d1-c563-811d-0a4c-ae100780e2dd