Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1978-07-12
- Stop
- 1978-07-12
The parties
- Patient
- patient Adalberto Earle Berge
- Provider
- provider Alesha Wilderman
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
2a29ee86-7b2f-4e27-c16d-6fc3959adac6