Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-07-07
- Stop
- 2021-07-07
The parties
- Patient
- patient Nona Samara Gleichner
- Provider
- provider Efren Sporer
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Humana
Record id
0042ca65-dd9d-7221-dea8-c64180b15f08