Claim total
$780.93
base $93.39 · payer covered $730.93
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2024-09-28
- Stop
- 2024-09-28
The parties
- Patient
- patient Belva Nadene Kuphal
- Provider
- provider Shonta Hayes
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
0430ce7c-cb64-da75-ecfe-fcd63bc6d1c2