Claim total
$1,935.01
base $93.83 · payer covered $1,935.01
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-03-31
- Stop
- 2024-03-31
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-f493-6a516f163c52