Claim total
$840.41
base $93.83 · payer covered $740.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-11-21
- Stop
- 2022-11-21
The parties
- Patient
- patient Elliot Blaine Buckridge
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
00a5a31e-a2f8-175f-25b9-d07c90985341