Claim total
$838.28
base $93.83 · payer covered $738.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-05-15
- Stop
- 2011-05-15
The parties
- Patient
- patient Krista Jenniffer Kautzer
- Provider
- provider Danilo Haley
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0f6846d9-5866-3324-b5d3-80cd5bd91fea