Claim total
$910.06
base $93.83 · payer covered $760.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1981-04-15
- Stop
- 1981-04-15
The parties
- Patient
- patient Susanna Avis Emard
- Provider
- provider Danilo Haley
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0443166c-c803-503e-45d9-4d0b728b0ea1