Claim total
$1,333.91
base $93.83 · payer covered $1,183.91
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1980-12-18
- Stop
- 1980-12-18
The parties
- Patient
- patient Katie Glynis Lang
- Provider
- provider Maryam Wolf
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
3651568f-224f-59a6-c50e-3e6b57eeedf0