Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1984-05-02
- Stop
- 1984-05-02
The parties
- Patient
- patient Susanna Avis Emard
- Provider
- provider Alesha Wilderman
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0443166c-c803-503e-0ca9-d0fdc07e8af2