Claim total
$1,200.34
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1977-09-30
- Stop
- 1977-09-30
The parties
- Patient
- patient Brooks Fred Jones
- Provider
- provider Shoshana Runolfsdottir
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
1b22a3c2-c430-b888-5f29-90cbb9ef1158