Claim total
$847.72
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-10-04
- Stop
- 2016-10-05
The parties
- Patient
- patient Blake Rudolph Von
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Aetna
Record id
01986319-54e6-598a-f36c-88a6e79ee697