Claim total
$1,251.43
base $93.83 · payer covered $1,151.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-06-14
- Stop
- 2021-06-14
The parties
- Patient
- patient Lashon Ara Stiedemann
- Provider
- provider Tennille Baumbach
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Medicaid
Record id
2a7bc9cf-4171-efe5-62da-1730157e2c9f