Claim total
$903.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-05-21
- Stop
- 2014-05-21
The parties
- Patient
- patient Jefferson Fredrick Stamm
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Humana
Record id
02e8a145-6422-3c9c-2bde-649889238308