Claim total
$777.13
base $93.83 · payer covered $677.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-10-18
- Stop
- 2019-10-18
The parties
- Patient
- patient Carmel Candace Corwin
- Provider
- provider Niki O'Kon
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
05f2be84-5448-13b2-2a97-125bbad16f2c