Claim total
$911.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-04-22
- Stop
- 2002-04-22
The parties
- Patient
- patient Randa Deloris Kassulke
- Provider
- provider Fernande Predovic
- Care site
- care site TWIN CITIES MEDICAL CLINIC PC
- Payer
- payer No insurance
Record id
3305d82e-693f-73b2-f3e4-af69afad93ed