Claim total
$711.72
base $93.83 · payer covered $711.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-03-19
- Stop
- 2019-03-19
The parties
- Patient
- patient Sherryl Dion Collier
- Provider
- provider Jaime Jacobi
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
2ff124fd-32f0-2d7e-6c2f-1986a620d695