Claim total
$777.13
base $93.83 · payer covered $677.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-06-12
- Stop
- 2009-06-12
The parties
- Patient
- patient Liz Loriann Kovacek
- Provider
- provider Tennille Baumbach
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Medicaid
Record id
31f0e3c1-608c-dfd8-751b-ed72af932f2b