Claim total
$1,281.42
base $93.83 · payer covered $1,131.42
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-08-27
- Stop
- 1997-08-27
The parties
- Patient
- patient Marion Angelo Bogisich
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
0b1b278b-2e00-e569-37c8-c749d286095f