Claim total
$1,178.99
base $93.83 · payer covered $1,178.99
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-03-19
- Stop
- 2019-03-19
The parties
- Patient
- patient Jacqui Bess Baumbach
- Provider
- provider Trevor Williamson
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
019cda32-2557-7f65-da74-4693ffb354cc