Claim total
$917.37
base $93.83 · payer covered $767.37
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1971-11-27
- Stop
- 1971-11-27
The parties
- Patient
- patient Elbert Rod Lemke
- Provider
- provider Shonta Hayes
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
039e51d1-c563-811d-a5f2-9b50ed060f10