Claim total
$704.41
base $93.83 · payer covered $554.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-10-29
- Stop
- 2002-10-29
The parties
- Patient
- patient Jacqui Bess Baumbach
- Provider
- provider Trevor Williamson
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
019cda32-2557-7f65-9764-43d513d8504e