Claim total
$916.15
base $93.83 · payer covered $866.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2000-02-16
- Stop
- 2000-02-16
The parties
- Patient
- patient Martín Ramón Chacón
- Provider
- provider Lola Fadel
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0b2edf0d-f30f-28e2-48dc-48804036d5ae