Claim total
$780.15
base $93.83 · payer covered $630.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1986-03-25
- Stop
- 1986-03-25
The parties
- Patient
- patient Dane Cyrus Prosacco
- Provider
- provider Nicolas Raynor
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
08d84e2a-24fc-df43-f40e-b1bceb2e3a2b