Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-03-19
- Stop
- 2013-03-19
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Lola Fadel
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
0274bb53-c777-eb96-81d9-267cddff4b41