Claim total
$1,049.33
base $93.83 · payer covered $1,049.33
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2008-05-13
- Stop
- 2008-05-13
The parties
- Patient
- patient Soledad Delores Renner
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
2201f761-9b24-e098-15c9-36e060430955