Claim total
$979.43
base $93.83 · payer covered $829.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1995-08-31
- Stop
- 1995-08-31
The parties
- Patient
- patient Mollie Desire Murazik
- Provider
- provider Fernande Predovic
- Care site
- care site TWIN CITIES MEDICAL CLINIC PC
- Payer
- payer Medicaid
Record id
2c990e44-6147-5419-33b8-01b518e236d7