Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-06-19
- Stop
- 2025-06-19
The parties
- Provider
- provider Bradley Terry
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
04dc5210-87cc-ee45-750e-cac5d9a7cc27