Claim total
$1,115.43
base $93.83 · payer covered $1,015.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-11-25
- Stop
- 2007-11-25
The parties
- Patient
- patient Willian Mante
- Provider
- provider Tennille Baumbach
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Medicaid
Record id
1a965d90-6476-30d5-a2ce-b670bec86cef