Claim total
$836.12
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1977-07-19
- Stop
- 1977-07-19
The parties
- Patient
- patient Modesto Kunze
- Provider
- provider Thomasine Balistreri
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
1358e0d6-1806-b993-9995-0fa94bcf0395