Claim total
$767.69
base $93.83 · payer covered $667.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-03-10
- Stop
- 2020-03-10
The parties
- Patient
- patient Dane Cyrus Prosacco
- Provider
- provider Tyrone Stracke
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Medicaid
Record id
08d84e2a-24fc-df43-9ad0-ae58b8b4866f