Claim total
$964.89
base $93.83 · payer covered $908.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-04-27
- Stop
- 2018-04-27
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-f612-3b90-fc944fa57252