Claim total
$636.84
base $93.83 · payer covered $636.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-11-12
- Stop
- 2020-11-12
The parties
- Patient
- patient Raleigh Marlon Quitzon
- Provider
- provider Norris Kertzmann
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
36d18d55-3a3e-3ebd-94e1-3a642780a6dc