Claim total
$906.71
base $93.83 · payer covered $756.71
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1968-12-25
- Stop
- 1968-12-25
The parties
- Patient
- patient Mauro Long Emmerich
- Provider
- provider Marchelle Jakubowski
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
23076cc7-987a-7400-e0c9-7ddf79b4432b