Claim total
$639.76
base $93.83 · payer covered $639.76
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-12-06
- Stop
- 2017-12-06
The parties
- Patient
- patient Ronald Inga Torphy
- Provider
- provider Maryam Wolf
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
05af61d0-e78c-a60a-13ef-301fff95e3db