Claim total
$1,127.91
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-02-12
- Stop
- 2014-02-12
The parties
- Patient
- patient Felipe Dwain Keebler
- Provider
- provider Winfred Gaylord
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Humana
Record id
02f04cf4-122a-e8d3-63fe-44191d06259b