Claim total
$777.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-08-27
- Stop
- 2019-08-28
The parties
- Patient
- patient Adalberto Al Connelly
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Anthem
Record id
0d29108a-1daf-b1af-5c10-4882742aad82