Claim total
$1,104.10
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-05-05
- Stop
- 2010-05-05
The parties
- Patient
- patient Felipe Dwain Keebler
- Provider
- provider Jaime Jacobi
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Humana
Record id
02f04cf4-122a-e8d3-5b1c-69f7ae3432f9