Claim total
$1,289.04
base $93.83 · payer covered $1,239.04
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-11-04
- Stop
- 1997-11-04
The parties
- Patient
- patient Sherryl Dion Collier
- Provider
- provider Winfred Gaylord
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
2ff124fd-32f0-2d7e-5fa7-548d5ff8c439