Claim total
$973.34
base $93.83 · payer covered $973.34
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-12-04
- Stop
- 2018-12-04
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-f6e0-1fc1ce0fb87e