Claim total
$1,300.65
base $93.83 · payer covered $1,265.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-06-12
- Stop
- 1991-06-12
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-d863-c90cba2ff75d