Claim total
$780.15
base $93.83 · payer covered $780.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-05-01
- Stop
- 2009-05-01
The parties
- Patient
- patient Gus Clair Nitzsche
- Provider
- provider Jaime Jacobi
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
105ade21-1b58-baca-f30f-b9c4f0a89866