Claim total
$1,047.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-03-02
- Stop
- 2018-03-02
The parties
- Patient
- patient Ellena Eartha Cassin
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
2c69d807-451d-7a16-edc7-4345f86e8279