Claim total
$903.69
base $93.83 · payer covered $903.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-06-02
- Stop
- 2026-06-02
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Deloras Lesch
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
0274bb53-c777-eb96-0291-145300564c56