Claim total
$972.12
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2001-12-27
- Stop
- 2001-12-27
The parties
- Patient
- patient Mike Jess Block
- Provider
- provider Modesto Pagac
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer No insurance
Record id
0ebb1b72-dae4-3292-e0f8-cbc00c7387ad