Claim total
$836.12
base $93.83 · payer covered $686.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1967-05-21
- Stop
- 1967-05-21
The parties
- Patient
- patient Buddy Bradly Bradtke
- Provider
- provider Norris Kertzmann
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
207161b0-f503-ec70-9c98-7f5446130abd