Claim total
$840.41
base $93.83 · payer covered $256.09
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-07-30
- Stop
- 2025-07-30
The parties
- Patient
- patient Nona Samara Gleichner
- Provider
- provider Thomasine Balistreri
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Humana
Record id
0042ca65-dd9d-7221-777c-b8b3e35d4b49