Claim total
$777.13
base $93.83 · payer covered $777.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-03-31
- Stop
- 2015-03-31
The parties
- Patient
- patient Rocio Margarita Alcaraz
- Provider
- provider Marchelle Jakubowski
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
0274bb53-c777-eb96-a6d6-512ec2d5e448