Claim total
$1,123.02
base $93.83 · payer covered $1,123.02
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-04-11
- Stop
- 2023-04-11
The parties
- Patient
- patient Jacqui Bess Baumbach
- Provider
- provider Sofia Conroy
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
019cda32-2557-7f65-826e-0f2710f84b82