Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1973-09-13
- Stop
- 1973-09-13
The parties
- Patient
- patient Mikel Edmond Wisoky
- Provider
- provider Alesha Wilderman
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
2973ea9a-f1cd-e339-5dea-7a6675447843