Claim total
$767.69
base $93.83 · payer covered $667.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-12-24
- Stop
- 2017-12-24
The parties
- Patient
- patient Novella Consuelo Nicolas
- Provider
- provider Danilo Haley
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
073c3e67-985b-6205-fdcf-ec6da86ff5d9