Claim total
$780.15
base $93.83 · payer covered $730.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2000-10-04
- Stop
- 2000-10-04
The parties
- Patient
- patient Walter Rudolph Little
- Provider
- provider Shoshana Runolfsdottir
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
361a4d7c-124b-a34d-8b20-33cefa9357da