Claim total
$767.69
base $93.83 · payer covered $667.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-05-12
- Stop
- 2015-05-12
The parties
- Patient
- patient Louella Roberts
- Provider
- provider Shoshana Runolfsdottir
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
05092f50-4c35-2d72-0a71-b303f521ca96