Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1981-04-16
- Stop
- 1981-04-16
The parties
- Patient
- patient Terrell Allan Walter
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0c1ee120-1dc7-6b68-db01-f8db2e77e350