Claim total
$777.13
base $93.83 · payer covered $677.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2021-04-06
- Stop
- 2021-04-06
The parties
- Patient
- patient Nicky Kristi Wiegand
- Provider
- provider Tennille Baumbach
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Medicaid
Record id
0358d022-e88b-b208-d810-0b82619cecdd