Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-10-01
- Stop
- 2004-10-01
The parties
- Patient
- patient Norris Trey Roob
- Provider
- provider Shonta Hayes
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer No insurance
Record id
1cdc08a2-70d1-027e-54ec-7bb32e08ea21