Claim total
$1,112.41
base $93.83 · payer covered $1,055.80
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-12-18
- Stop
- 2022-12-18
The parties
- Patient
- patient Winifred Lelah Zulauf
- Provider
- provider Alesha Wilderman
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
1422a51d-cc3d-7733-5b43-bda8f3dcb771