Claim total
$711.72
base $93.83 · payer covered $611.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-03-17
- Stop
- 2026-03-17
The parties
- Patient
- patient Louella Roberts
- Provider
- provider Shoshana Runolfsdottir
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
05092f50-4c35-2d72-29bd-d9477bfbd52a