Claim total
$773.83
base $93.83 · payer covered $673.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-11-02
- Stop
- 2019-11-02
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-cb5b-78c2881c783d