Claim total
$1,602.75
base $93.83 · payer covered $1,502.75
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-03-06
- Stop
- 2020-03-06
The parties
- Patient
- patient Isela Lisbeth Lang
- Provider
- provider Olin Mosciski
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
310def7b-a5c6-df96-9a75-de22cc35c272