Claim total
$899.40
base $93.83 · payer covered $749.40
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1974-10-18
- Stop
- 1974-10-18
The parties
- Patient
- patient Kizzy Blondell Hermann
- Provider
- provider Joaquin Krajcik
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0fa13c65-5aee-f679-12ec-6c1befd48683