Claim total
$1,249.58
base $93.83 · payer covered $1,249.58
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-04-16
- Stop
- 2024-04-16
The parties
- Patient
- patient Jacqui Bess Baumbach
- Provider
- provider Trevor Williamson
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
019cda32-2557-7f65-0853-5890f168e06b