Claim total
$910.06
base $93.83 · payer covered $760.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1972-06-03
- Stop
- 1972-06-03
The parties
- Patient
- patient Irving Steve Legros
- Provider
- provider Jaime Jacobi
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
02796652-7893-0df9-7569-44b249a8f3ad