Claim total
$973.34
base $93.83 · payer covered $923.34
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-09-18
- Stop
- 2003-09-18
The parties
- Provider
- provider Adriene Wisozk
- Care site
- care site TWIN CITIES MEDICAL CLINIC PC
- Payer
- payer Medicaid
Record id
389a6c0d-c9f5-2cd8-2d9a-dddd9531fc50