Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-08-02
- Stop
- 2023-08-02
The parties
- Patient
- patient Adalberto Earle Berge
- Provider
- provider Danilo Haley
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
2a29ee86-7b2f-4e27-4f16-dbc0dc46a1be