Claim total
$704.41
base $93.83 · payer covered $669.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1989-05-31
- Stop
- 1989-05-31
The parties
- Patient
- patient Susanna Avis Emard
- Provider
- provider Alesha Wilderman
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
0443166c-c803-503e-d50a-ccce3af363e3