Claim total
$1,029.00
base $93.83 · payer covered $972.39
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-08-22
- Stop
- 2015-08-22
The parties
- Patient
- patient Alec Jesse Schultz
- Provider
- provider Margarite Dibbert
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
1afed4d0-5acb-3272-5a57-9ca591edbda6