Claim total
$1,185.08
base $93.83 · payer covered $1,185.08
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-08-07
- Stop
- 2006-08-07
The parties
- Patient
- patient Jovan Isabel Okuneva
- Provider
- provider Alesha Wilderman
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0ad0b04b-62fb-fe8a-5c6f-c52a76c36f95