Claim total
$773.83
base $93.83 · payer covered $773.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2014-11-25
- Stop
- 2014-11-25
The parties
- Patient
- patient Cristobal Dana Wolf
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
016cc0d6-9a88-e8dc-e30e-caa569d7b492