Claim total
$880.04
base $93.83 · payer covered $780.04
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-12-10
- Stop
- 2017-12-10
The parties
- Patient
- patient Jon Lavern Baumbach
- Provider
- provider Robin Stokes
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
033f4a7e-c2bc-1f12-3ed2-fc04fbbb69f1