Claim total
$1,214.92
base $93.83 · payer covered $1,214.92
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-12-21
- Stop
- 2021-12-21
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-e097-523007431c06