Claim total
$704.41
base $93.83 · payer covered $554.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-05-14
- Stop
- 2004-05-14
The parties
- Patient
- patient Myles Kristofer Kub
- Provider
- provider Tennille Baumbach
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Medicaid
Record id
22e8a807-5128-01a6-5f0b-12e519dbb580