Claim total
$940.20
base $93.83 · payer covered $940.20
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-03-20
- Stop
- 2022-03-20
The parties
- Patient
- patient Cecil Norberto Franecki
- Provider
- provider Jaime Jacobi
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
05e47734-a2d3-8a46-a410-5f65b6451238