Claim total
$505.13
base $93.83 · payer covered $355.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1942-04-29
- Stop
- 1942-04-29
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-82fa-098bfe6a83ab