Claim total
$976.41
base $93.83 · payer covered $976.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-04-05
- Stop
- 2016-04-05
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Horacio Baumbach
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
0274bb53-c777-eb96-abcb-292000bfd3a3