Claim total
$772.84
base $93.83 · payer covered $672.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-10-01
- Stop
- 2019-10-01
The parties
- Patient
- patient Teodoro Alfredo Gómez
- Provider
- provider Samantha Schmidt
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
08dcff5d-0575-4c96-120e-473f7703452a