Claim total
$1,112.36
base $93.83 · payer covered $962.36
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1986-01-02
- Stop
- 1986-01-02
The parties
- Patient
- patient Edmond Buck Frami
- Provider
- provider Danilo Haley
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
2dadf8ee-904b-645a-6354-01589d2eda2c