Claim total
$291.66
base $155.66 · payer covered $241.66
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-12-22
- Stop
- 2021-12-22
The parties
- Provider
- provider Nicolas Raynor
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
010d736c-d81f-3cd7-8a45-8b2a0b123806