Claim total
$1,251.43
base $93.83 · payer covered $1,251.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-03-20
- Stop
- 2007-03-20
The parties
- Patient
- patient Ryann Angelique Kilback
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
15815cb5-e62a-564b-f5e4-58640d9811be