Claim total
$985.80
base $93.83 · payer covered $835.80
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1972-02-14
- Stop
- 1972-02-14
The parties
- Patient
- patient Oralia Quitzon
- Provider
- provider Adriene Wisozk
- Care site
- care site TWIN CITIES MEDICAL CLINIC PC
- Payer
- payer Medicaid
Record id
0eb80311-b4cb-d3cb-6e25-4590d073dfd6