Claim total
$1,345.79
base $93.83 · payer covered $1,295.79
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-02-13
- Stop
- 1997-02-13
The parties
- Patient
- patient Millie Latrina Franecki
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
293b5046-ff66-69d2-d3a9-3db7a9558e32