Claim total
$1,361.96
base $93.83 · payer covered $1,261.96
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2023-08-05
- Stop
- 2023-08-05
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-64a5-0f6464f4750c