Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-05-17
- Stop
- 2015-05-18
The parties
- Patient
- patient Heriberto Bennie Walsh
- Provider
- provider Niki O'Kon
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
02b5c001-4bdb-16d2-dda7-64f8717cd6d0