Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-08-07
- Stop
- 2021-08-07
The parties
- Patient
- patient Belva Nadene Kuphal
- Provider
- provider Gwenn Hermann
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
0430ce7c-cb64-da75-c30d-c8f73e7e4bd6