Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-12-10
- Stop
- 2019-12-10
The parties
- Patient
- patient Queen Sharika Fay
- Provider
- provider Norris Kertzmann
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
02c148c0-182c-a5fd-4cbf-ef6aaea49bba