Claim total
$435.48
base $93.83 · payer covered $335.48
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2021-12-29
- Stop
- 2021-12-29
The parties
- Patient
- patient Ronald Inga Torphy
- Provider
- provider Gwenn Hermann
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
05af61d0-e78c-a60a-6f7e-b7b3f61c1518