Claim total
$1,391.01
base $93.83 · payer covered $1,241.01
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1978-06-10
- Stop
- 1978-06-10
The parties
- Patient
- patient Irving Steve Legros
- Provider
- provider Winfred Gaylord
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
02796652-7893-0df9-fc45-88561f80ebff