Claim total
$1,052.43
base $93.83 · payer covered $952.43
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-12-18
- Stop
- 2019-12-18
The parties
- Patient
- patient Ronald Inga Torphy
- Provider
- provider Nicolas Raynor
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
05af61d0-e78c-a60a-41b0-4438e82be247