Claim total
$846.78
base $93.83 · payer covered $746.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-04-23
- Stop
- 2019-04-23
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Deloras Lesch
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0274bb53-c777-eb96-634b-9ce3b07d8279