Claim total
$1,256.67
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-01-21
- Stop
- 2023-01-21
The parties
- Patient
- patient Elois Felisha Simonis
- Provider
- provider Samantha Schmidt
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
39162559-8ecc-f67b-f1f2-5586c1a31f0d