Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-05-25
- Stop
- 2017-05-25
The parties
- Patient
- patient Michal Andrew Champlin
- Provider
- provider Florentino Boehm
- Payer
- payer Humana
Record id
01866125-a841-a217-6270-cf153d340085