Claim total
$641.13
base $93.83 · payer covered $591.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1992-10-13
- Stop
- 1992-10-13
The parties
- Patient
- patient Jacqui Bess Baumbach
- Provider
- provider Britt Sipes
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
019cda32-2557-7f65-ced9-066ce3ef3320