Claim total
$906.71
base $93.83 · payer covered $806.71
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-08-15
- Stop
- 2022-08-15
The parties
- Patient
- patient Libby Celine Gorczany
- Provider
- provider Jaime Jacobi
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
369882ce-78fe-11ba-4833-948bde477d4f