Claim total
$780.15
base $93.83 · payer covered $730.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-11-29
- Stop
- 2002-11-29
The parties
- Provider
- provider Jaime Jacobi
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
27d44017-ab24-4e1b-95b3-79903dc34bce