Claim total
$704.41
base $93.83 · payer covered $554.41
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2004-07-05
- Stop
- 2004-07-05
The parties
- Patient
- patient Libby Celine Gorczany
- Provider
- provider Vicente McClure
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
369882ce-78fe-11ba-7ab5-0cb460fc9531