Claim total
$1,271.72
base $93.83 · payer covered $293.44
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-04-29
- Stop
- 2019-04-29
The parties
- Patient
- patient Vella Divina Renner
- Provider
- provider Samantha Schmidt
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer UnitedHealthcare
Record id
02404bb7-0f7d-3a30-39e2-d98c955e0a5c