Claim total
$704.41
base $93.83 · payer covered $554.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1982-05-05
- Stop
- 1982-05-05
The parties
- Patient
- patient Ricky Michal Wisozk
- Provider
- provider Norris Kertzmann
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
1ed700c5-df9c-e290-8ebb-749fe76b809d