Claim total
$1,244.12
base $93.83 · payer covered $1,144.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-08-12
- Stop
- 2012-08-12
The parties
- Patient
- patient Tisa Joya Stoltenberg
- Provider
- provider Jeanie Senger
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
2debd169-2d62-f488-0e44-c512ffb3e5df