Claim total
$985.80
base $93.83 · payer covered $885.80
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-12-13
- Stop
- 2012-12-14
The parties
- Patient
- patient Silva Thompson
- Provider
- provider Niki O'Kon
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
26cdcc71-805e-4168-c0bd-b5af3febf1f3