Claim total
$641.13
base $93.83 · payer covered $584.52
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-04-21
- Stop
- 2017-04-21
The parties
- Patient
- patient Carolynn Gabriele Zemlak
- Provider
- provider Niki O'Kon
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
032e4024-8595-f612-163d-aae828ac6ffe