Claim total
$435.48
base $93.83 · payer covered $435.48
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-09-29
- Stop
- 2018-09-29
The parties
- Patient
- patient Dorotea Yolanda Palomo
- Provider
- provider Shoshana Runolfsdottir
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
04ad2732-b952-4fbb-0a3e-d567a7373035