Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-01-11
- Stop
- 2004-01-11
The parties
- Patient
- patient Jaime Schoen
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
3834ec65-d16b-0c19-ca3b-d112c1859f3a