Claim total
$1,433.33
base $93.83 · payer covered $1,283.33
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1975-06-07
- Stop
- 1975-06-07
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-d4e3-0a70b180ca79