Claim total
$1,189.76
base $93.83 · payer covered $1,039.76
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-05-14
- Stop
- 2002-05-14
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Lola Fadel
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0274bb53-c777-eb96-b9c0-065dff2e7027