Claim total
$767.69
base $93.83 · payer covered $667.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-01-30
- Stop
- 2017-01-30
The parties
- Patient
- patient Elliot Blaine Buckridge
- Provider
- provider Norris Kertzmann
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
00a5a31e-a2f8-175f-44e8-a38020a5dedd