Claim total
$1,369.13
base $93.83 · payer covered $1,219.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1988-11-07
- Stop
- 1988-11-07
The parties
- Patient
- patient Merrilee Danika Lockman
- Provider
- provider Tim Borer
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
3a0268da-7888-d772-af20-5fb06aad291c