Claim total
$843.43
base $93.83 · payer covered $743.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2008-02-19
- Stop
- 2008-02-19
The parties
- Patient
- patient Nick Mitchell Swift
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
074a3e90-8d35-ba52-21ac-32fb49d6a0dc