Claim total
$1,602.91
base $93.83 · payer covered $1,502.91
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-03-03
- Stop
- 2020-03-03
The parties
- Patient
- patient Louella Roberts
- Provider
- provider Tim Borer
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
05092f50-4c35-2d72-1bdc-8d655278e2d5