Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1986-09-30
- Stop
- 1986-09-30
The parties
- Patient
- patient Lezlie Torp
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
109e9a50-b505-db69-49eb-5a4cb644249a