Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2012-12-06
- Stop
- 2012-12-06
The parties
- Patient
- patient Dona Fabiola Mohr
- Provider
- provider Fernande Predovic
- Care site
- care site TWIN CITIES MEDICAL CLINIC PC
- Payer
- payer Medicaid
Record id
08d3dad9-c063-9835-ab20-05e4ae8a011b