Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-10-06
- Stop
- 2017-10-06
The parties
- Patient
- patient Carmel Candace Corwin
- Provider
- provider Joaquin Krajcik
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
05f2be84-5448-13b2-e6b6-ce073ab10119