Claim total
$293.11
base $93.83 · payer covered $193.11
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-08-25
- Stop
- 2018-08-25
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-ee03-f04d044f130d