Claim total
$1,168.94
base $93.83 · payer covered $1,018.94
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1987-10-28
- Stop
- 1987-10-28
The parties
- Patient
- patient Mauro Long Emmerich
- Provider
- provider Lola Fadel
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
23076cc7-987a-7400-1d19-8c6b4bc52c05