Claim total
$641.13
base $93.83 · payer covered $584.52
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2026-08-22
- Stop
- 2026-08-22
The parties
- Patient
- patient Dorotea Yolanda Palomo
- Provider
- provider Shoshana Runolfsdottir
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
04ad2732-b952-4fbb-8cf6-5a1a28f2e91c