Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1968-11-23
- Stop
- 1968-11-23
The parties
- Patient
- patient Elbert Rod Lemke
- Provider
- provider Will Leuschke
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
039e51d1-c563-811d-45b7-79469e92fec5