Claim total
$910.06
base $93.83 · payer covered $810.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-08-01
- Stop
- 2014-08-01
The parties
- Patient
- patient Erwin Fredric Gibson
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
259579f5-e088-c375-f202-704fab9e030b