Claim total
$13,497.04
base $93.83 · payer covered $6,885.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-04-28
- Stop
- 2015-04-28
The parties
- Patient
- patient Lucretia Phillis Crooks
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
Record id
351eb513-0da1-4f70-e86a-135252129d58