Claim total
$1,191.67
base $93.83 · payer covered $1,191.67
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-11-17
- Stop
- 2015-11-17
The parties
- Patient
- patient Queen Sharika Fay
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
02c148c0-182c-a5fd-69cc-da5423080202