Claim total
$840.41
base $93.83 · payer covered $740.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-01-19
- Stop
- 2016-01-19
The parties
- Patient
- patient Elinore Danyelle Streich
- Provider
- provider Nicolas Raynor
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
03b3068a-a726-461a-3300-ae49fd83ecbd