Claim total
$1,395.02
base $93.83 · payer covered $1,395.02
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-03-01
- Stop
- 2016-03-01
The parties
- Patient
- patient Jacqui Bess Baumbach
- Provider
- provider Britt Sipes
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
019cda32-2557-7f65-03ec-ad1683ea86ae