Claim total
$979.43
base $93.83 · payer covered $979.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-05-05
- Stop
- 2009-05-05
The parties
- Patient
- patient Louella Roberts
- Provider
- provider Shoshana Runolfsdottir
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
05092f50-4c35-2d72-5106-23214e9531a3