Claim total
$862.92
base $93.83 · payer covered $712.92
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1984-06-26
- Stop
- 1984-06-27
The parties
- Patient
- patient Blake Rudolph Von
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
01986319-54e6-598a-ba9d-76a5aa5a5283