Claim total
$843.43
base $93.83 · payer covered $843.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-09-28
- Stop
- 2015-09-28
The parties
- Patient
- patient Minta Ashley Bradtke
- Provider
- provider Tyrone Stracke
- Care site
- care site HENNEPIN HEALTHCARE SYSTEM INC
- Payer
- payer Humana
Record id
30e44971-6530-f6f8-bb19-5916dc20ba7f