Claim total
$1,390.78
base $93.83 · payer covered $1,290.78
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-01-18
- Stop
- 2018-01-18
The parties
- Patient
- patient Daron Cormier
- Provider
- provider Shoshana Runolfsdottir
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
061edbc8-fb70-a6fd-db02-28eb8cc944cd