Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2001-07-04
- Stop
- 2001-07-04
The parties
- Patient
- patient Felipe Dwain Keebler
- Provider
- provider Jaime Jacobi
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Humana
Record id
02f04cf4-122a-e8d3-335d-baf9b05fd531