Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-02-10
- Stop
- 2004-02-10
The parties
- Patient
- patient Long Lee Koelpin
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
3262d190-0790-ed5d-933b-0e676c37469e