Claim total
$1,667.32
base $93.83 · payer covered $1,517.32
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-02-28
- Stop
- 2005-02-28
The parties
- Patient
- patient August Darrel Dach
- Provider
- provider Danilo Haley
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
092b8bdc-b84a-4582-48a3-3beea34a38d2