Claim total
$641.13
base $93.83 · payer covered $534.52
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1988-05-25
- Stop
- 1988-05-25
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-5b98-7b7458e853ce