Claim total
$846.78
base $93.83 · payer covered $846.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-10-31
- Stop
- 2020-10-31
The parties
- Provider
- provider Tennille Baumbach
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Dual Eligible
Record id
021142be-3a32-af72-fb97-d2e2a902407d