Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-12-28
- Stop
- 2011-12-28
The parties
- Patient
- patient Nichol Clara Predovic
- Provider
- provider Vena Champlin
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Humana
Record id
0130f9d2-4df9-4b02-386d-b8b05923c717