Claim total
$906.71
base $93.83 · payer covered $756.71
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-10-31
- Stop
- 2002-10-31
The parties
- Patient
- patient Brock Josiah Gaylord
- Provider
- provider Jarred Jenkins
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
2d5d1e2a-d4d9-a177-1a47-cd93d1ddd454