Claim total
$772.84
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-06-17
- Stop
- 2013-06-17
The parties
- Patient
- patient Suzy Alyson Gutmann
- Provider
- provider Julene Lemke
- Payer
- payer Humana
Record id
172e3d48-7ef1-d07b-29ea-b259379aaabc