Claim total
$1,173.66
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-05-05
- Stop
- 2016-05-05
The parties
- Patient
- patient Slyvia Kymberly Dibbert
- Provider
- provider Winfred Gaylord
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Humana
Record id
1263b62e-c014-f602-50fc-aa739f3f3561