Claim total
$1,506.92
base $93.83 · payer covered $1,356.92
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1962-06-22
- Stop
- 1962-06-22
The parties
- Patient
- patient Sharell Herma Schaden
- Provider
- provider Hiram Nitzsche
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
19f98f29-fa6f-31a8-f193-f45fb28da2eb