Claim total
$1,561.64
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1984-06-18
- Stop
- 1984-06-18
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-73b2-5a5f-a794e0e3ea80