Claim total
$1,490.42
base $93.83 · payer covered $1,390.42
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-07-30
- Stop
- 2025-07-30
The parties
- Patient
- patient Walter Rudolph Little
- Provider
- provider Tim Borer
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
361a4d7c-124b-a34d-9b9d-1ab0e44002e2