Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2020-03-08
- Stop
- 2020-03-08
The parties
- Patient
- patient Cecil Norberto Franecki
- Provider
- provider Winfred Gaylord
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
05e47734-a2d3-8a46-9185-6e3f744225ec