Claim total
$846.78
base $93.83 · payer covered $790.17
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-12-12
- Stop
- 2017-12-12
The parties
- Patient
- patient Cristobal Dana Wolf
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
016cc0d6-9a88-e8dc-fd8a-7b129c63e65d