Claim total
$1,066.64
base $93.83 · payer covered $966.64
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-08-24
- Stop
- 2024-08-24
The parties
- Patient
- patient Bradford Jamey Weimann
- Provider
- provider Cleotilde Herman
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
074ddd08-22b4-a810-326d-c67f8bbcd23e