Claim total
$1,051.00
base $93.83 · payer covered $1,016.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-07-24
- Stop
- 2004-07-24
The parties
- Patient
- patient Benito Delao
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
30bb6e62-6649-f6c6-3ef5-603acfe4111b