Claim total
$772.84
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-03-16
- Stop
- 1991-03-16
The parties
- Patient
- patient Milissa Tien Smitham
- Provider
- provider Cornelius Jacobi
- Care site
- care site MECCA MEDICAL CENTER, LLC
- Payer
- payer No insurance
Record id
20b28cd3-f10e-9c06-891f-326496269213