Claim total
$641.13
base $93.83 · payer covered $591.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1998-05-30
- Stop
- 1998-05-30
The parties
- Patient
- patient Josefina Mojica
- Provider
- provider Norris Kertzmann
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
06d3e002-d020-7c66-8cd4-bcb42931a9d6