Claim total
$1,457.36
base $93.83 · payer covered $1,422.36
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-02-21
- Stop
- 1997-02-21
The parties
- Patient
- patient Gus Clair Nitzsche
- Provider
- provider Winfred Gaylord
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Dual Eligible
Record id
105ade21-1b58-baca-542e-e602b9e54707